Healthcare Provider Details

I. General information

NPI: 1720940661
Provider Name (Legal Business Name): DJR 24HOURRS RESIDENTIAL LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/01/2025
Last Update Date: 12/01/2025
Certification Date: 11/30/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12109 SE HIGH CREEK RD 12109 SE HIGH CREEK RD
HAPPY VALLEY OR
97086-4729
US

IV. Provider business mailing address

12109 SE HIGH CREEK RD
HAPPY VALLEY OR
97086-4729
US

V. Phone/Fax

Practice location:
  • Phone: 336-995-2670
  • Fax:
Mailing address:
  • Phone: 336-995-2670
  • Fax: 336-995-2670

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WM0705X
TaxonomyMedical-Surgical Registered Nurse
License Number
License Number State

VIII. Authorized Official

Name: MR. ERMIAS MULUGETA TEKLE SR.
Title or Position: EXECUTIVE DIRECTOR
Credential: RN
Phone: 336-995-2670