Healthcare Provider Details

I. General information

NPI: 1477832053
Provider Name (Legal Business Name): FIRST ADVENT MISSION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/12/2011
Last Update Date: 08/17/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1055 N 5TH ST UNIT 93
JACKSONVILLE OR
97530-9654
US

IV. Provider business mailing address

1055 N 5TH ST UNIT 93
JACKSONVILLE OR
97530-9654
US

V. Phone/Fax

Practice location:
  • Phone: 541-702-2204
  • Fax:
Mailing address:
  • Phone: 541-702-2204
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code372500000X
TaxonomyChore Provider
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code374U00000X
TaxonomyHome Health Aide
License Number
License Number State

VIII. Authorized Official

Name: SHARON LEE SHIELDS
Title or Position: IN HOME SERVICES
Credential:
Phone: 541-702-2204