Healthcare Provider Details

I. General information

NPI: 1073478483
Provider Name (Legal Business Name): EQUITABLE HEALTH SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/17/2025
Last Update Date: 12/17/2025
Certification Date: 12/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10354 NE WASCO ST
PORTLAND OR
97220-3927
US

IV. Provider business mailing address

10354 NE WASCO ST
PORTLAND OR
97220-3927
US

V. Phone/Fax

Practice location:
  • Phone: 503-572-8705
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code385H00000X
TaxonomyRespite Care
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code164W00000X
TaxonomyLicensed Practical Nurse
License Number
License Number State

VIII. Authorized Official

Name: ABRAHAM MERESSA
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 503-572-8705