Healthcare Provider Details

I. General information

NPI: 1619591476
Provider Name (Legal Business Name): VENACARE NW
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/07/2020
Last Update Date: 09/01/2023
Certification Date: 09/01/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6464 SW BORLAND RD STE C5
TUALATIN OR
97062-8856
US

IV. Provider business mailing address

6464 SW BORLAND RD STE C5
TUALATIN OR
97062-8856
US

V. Phone/Fax

Practice location:
  • Phone: 503-878-5418
  • Fax: 888-972-9515
Mailing address:
  • Phone: 503-878-5418
  • Fax: 888-972-9515

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code246RP1900X
TaxonomyPhlebotomy Technician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code261QH0100X
TaxonomyHealth Service Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MR. FRANK CAPOBIANCO
Title or Position: CEO
Credential: NCPT
Phone: 503-878-5418