Healthcare Provider Details

I. General information

NPI: 1205757523
Provider Name (Legal Business Name): EYOELRTH LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/22/2026
Last Update Date: 07/22/2026
Certification Date: 07/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15883 SE UPMAN WAY
DAMASCUS OR
97089-6852
US

IV. Provider business mailing address

15883 SE UPMAN WAY
DAMASCUS OR
97089-6852
US

V. Phone/Fax

Practice location:
  • Phone: 513-344-1057
  • Fax:
Mailing address:
  • Phone: 513-344-1057
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State

VIII. Authorized Official

Name: EYOEL HUSSEN
Title or Position: ADMINISTRATOR
Credential:
Phone: 513-344-1057