Healthcare Provider Details

I. General information

NPI: 1487256004
Provider Name (Legal Business Name): TRISHA MAY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/09/2020
Last Update Date: 11/09/2020
Certification Date: 11/09/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14306 NE 101ST WAY
VANCOUVER WA
98682-1877
US

IV. Provider business mailing address

14306 NE 101ST WAY
VANCOUVER WA
98682-1877
US

V. Phone/Fax

Practice location:
  • Phone: 208-283-2193
  • Fax:
Mailing address:
  • Phone: 208-283-2193
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name: TRESHIA MAE THUESON
Title or Position: OWNER
Credential: RDN
Phone: 208-283-2193