Healthcare Provider Details

I. General information

NPI: 1376851352
Provider Name (Legal Business Name): COURTNEY FAMILY ENTERPRISES INCORPERATED
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/23/2010
Last Update Date: 09/23/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

202 NE KELLY AVE
GRESHAM OR
97030-7544
US

IV. Provider business mailing address

202 NE KELLY AVE
GRESHAM OR
97030-7544
US

V. Phone/Fax

Practice location:
  • Phone: 503-661-0600
  • Fax: 503-661-0677
Mailing address:
  • Phone: 503-661-0600
  • Fax: 503-661-0677

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number15-2170
License Number StateOR

VIII. Authorized Official

Name: MRS. MONICA E. COURTNEY
Title or Position: DIRECTOR
Credential: OWNER
Phone: 503-544-5837