Healthcare Provider Details

I. General information

NPI: 1144267667
Provider Name (Legal Business Name): TOUCHMARK AT FAIRWAY VILLAGE HOME HEALTH LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/01/2006
Last Update Date: 03/02/2021
Certification Date: 03/02/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2909 SE VILLAGE LOOP
VANCOUVER WA
98683-8108
US

IV. Provider business mailing address

5150 SW GRIFFITH DR
BEAVERTON OR
97005-2935
US

V. Phone/Fax

Practice location:
  • Phone: 360-254-2866
  • Fax: 360-883-3103
Mailing address:
  • Phone: 503-646-5186
  • Fax: 503-644-3568

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number011429
License Number StateWA

VIII. Authorized Official

Name: BRIAN EUGENE PRYOR
Title or Position: EXECUTIVE VICE PRESIDENT
Credential:
Phone: 503-646-5186