Healthcare Provider Details

I. General information

NPI: 1801933932
Provider Name (Legal Business Name): CDM SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/30/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11818 SE MILL PLAIN BLVD SUITE 415
VANCOUVER WA
98684-5089
US

IV. Provider business mailing address

11818 SE MILL PLAIN BLVD SUITE 415
VANCOUVER WA
98684-5089
US

V. Phone/Fax

Practice location:
  • Phone: 360-896-9695
  • Fax: 360-896-9732
Mailing address:
  • Phone: 360-896-9695
  • Fax: 360-896-9732

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License NumberIS-248 (HOME CARE)
License Number StateWA

VIII. Authorized Official

Name: MR. ERIC ERICKSON
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 360-896-9695