Healthcare Provider Details

I. General information

NPI: 1861413452
Provider Name (Legal Business Name): LEGACY VISITING NURSE ASSOCIATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/21/2006
Last Update Date: 09/06/2023
Certification Date: 09/06/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6475 SW BORLAND RD STE J
TUALATIN OR
97062-9708
US

IV. Provider business mailing address

PO BOX 4466
PORTLAND OR
97208-4466
US

V. Phone/Fax

Practice location:
  • Phone: 503-225-6372
  • Fax:
Mailing address:
  • Phone: 503-413-3958
  • Fax: 503-413-3212

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251G00000X
TaxonomyCommunity Based Hospice Care Agency
License NumberNA
License Number State
# 2
Primary TaxonomyN
Taxonomy Code315D00000X
TaxonomyInpatient Hospice
License NumberNA
License Number State

VIII. Authorized Official

Name: ANNA LOOMIS
Title or Position: CFO
Credential:
Phone: 503-415-5730