Healthcare Provider Details

I. General information

NPI: 1396274817
Provider Name (Legal Business Name): HOUSECALL PROVIDERS, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/08/2017
Last Update Date: 12/07/2021
Certification Date: 12/07/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5100 S MACADAM AVE STE 200
PORTLAND OR
97239-3827
US

IV. Provider business mailing address

315 SW 5TH AVE
PORTLAND OR
97204-1753
US

V. Phone/Fax

Practice location:
  • Phone: 971-202-5500
  • Fax: 971-202-5555
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code163WG0000X
TaxonomyGeneral Practice Registered Nurse
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code207QG0300X
TaxonomyGeriatric Medicine (Family Medicine) Physician
License Number
License Number State

VIII. Authorized Official

Name: THERESA K. LEARN
Title or Position: CHIEF FINANCIAL OFFICER
Credential: CPA
Phone: 503-416-1415