Healthcare Provider Details

I. General information

NPI: 1265529747
Provider Name (Legal Business Name): NORTH COAST HOME CARE, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/06/2006
Last Update Date: 10/20/2020
Certification Date: 10/20/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

210 IVY AVE
TILLAMOOK OR
97141-2216
US

IV. Provider business mailing address

210 IVY AVE
TILLAMOOK OR
97141-2216
US

V. Phone/Fax

Practice location:
  • Phone: 503-842-8755
  • Fax: 503-842-9992
Mailing address:
  • Phone: 503-842-8755
  • Fax: 503-842-9992

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code332BC3200X
TaxonomyCustomized Equipment (DME)
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code332BP3500X
TaxonomyParenteral & Enteral Nutrition Supplies (DME)
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code332BX2000X
TaxonomyOxygen Equipment & Supplies (DME)
License NumberNPC-0001368
License Number StateOR
# 4
Primary TaxonomyN
Taxonomy Code333300000X
TaxonomyEmergency Response System Companies
License Number
License Number State
# 5
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier122887
Identifier TypeMEDICAID
Identifier StateOR
Identifier Issuer

VIII. Authorized Official

Name: MR. KEVIN FISHER
Title or Position: PRESIDENT
Credential:
Phone: 503-842-8755