Healthcare Provider Details

I. General information

NPI: 1154463073
Provider Name (Legal Business Name): RIGHT AT HOME MIDWIFERY SERVICES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/14/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3712 SE 76TH AVE
PORTLAND OR
97206
US

IV. Provider business mailing address

3712 SE 76TH AVE
PORTLAND OR
97206
US

V. Phone/Fax

Practice location:
  • Phone: 503-314-9186
  • Fax: 503-771-5501
Mailing address:
  • Phone: 503-314-9186
  • Fax: 503-771-5501

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code176B00000X
TaxonomyMidwife
License NumberLM112
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code176B00000X
TaxonomyMidwife
License NumberDEM LD 269194
License Number StateOR

VIII. Authorized Official

Name: MRS. ELEANOR ELIZABETH LEGARE
Title or Position: LLC MEMBER
Credential: LDM CPM
Phone: 503-314-9186