Healthcare Provider Details

I. General information

NPI: 1144951716
Provider Name (Legal Business Name): ZACHARY & ROOBLE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/23/2022
Last Update Date: 06/24/2022
Certification Date: 06/24/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20632 SE MAIN DR
GRESHAM OR
97030-2250
US

IV. Provider business mailing address

20632 SE MAIN DR
GRESHAM OR
97030-2250
US

V. Phone/Fax

Practice location:
  • Phone: 503-912-6577
  • Fax: 503-328-6055
Mailing address:
  • Phone: 503-912-6577
  • Fax: 503-328-6055

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251J00000X
TaxonomyNursing Care Agency
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: IFRAH S MOHAMMED
Title or Position: REGISTER NURSE/ MANAGER
Credential: RN
Phone: 503-912-6577