Healthcare Provider Details

I. General information

NPI: 1790076792
Provider Name (Legal Business Name): DANMAR, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/25/2011
Last Update Date: 06/07/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

825 NE 20TH AVE SUITE 336
PORTLAND OR
97232-2275
US

IV. Provider business mailing address

825 NE 20TH AVE SUITE 336
PORTLAND OR
97232-2275
US

V. Phone/Fax

Practice location:
  • Phone: 503-688-5575
  • Fax: 503-688-5950
Mailing address:
  • Phone: 503-688-5575
  • Fax: 503-688-5950

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number13-1501
License Number StateOR
# 2
Primary TaxonomyN
Taxonomy Code251F00000X
TaxonomyHome Infusion Agency
License Number
License Number StateOR
# 3
Primary TaxonomyN
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number StateOR

VIII. Authorized Official

Name: MS. MARY J. KIDD
Title or Position: OWNER/BRANCH MANAGER
Credential:
Phone: 503-688-5575