Healthcare Provider Details

I. General information

NPI: 1790882496
Provider Name (Legal Business Name): RKSO LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/17/2006
Last Update Date: 11/16/2023
Certification Date: 11/16/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

416 NE 87TH AVE STE 2
VANCOUVER WA
98664-1930
US

IV. Provider business mailing address

416 NE 87TH AVE STE 2
VANCOUVER WA
98664-1930
US

V. Phone/Fax

Practice location:
  • Phone: 360-253-4367
  • Fax: 360-213-1602
Mailing address:
  • Phone: 360-253-4367
  • Fax: 360-213-1602

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License NumberCF00058058
License Number StateWA
# 2
Primary TaxonomyN
Taxonomy Code332BX2000X
TaxonomyOxygen Equipment & Supplies (DME)
License NumberCF00058058
License Number StateWA

VIII. Authorized Official

Name: NICHOLE TAYLOR
Title or Position: OWNER
Credential:
Phone: 360-253-4367