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General NPI Number Information
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NPI Number | 1003307653
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Entity Type | Organization
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Legal Business Name | RESCUE LIFE SENIOR CARE AGENCY
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Dates
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Enumeration Date | 05/18/2018
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Last Update Date | 05/18/2018
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Provider Practice Location Address
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Address Line | 12640 SE STARK ST
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City | PORTLAND
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State | OR
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Zip | 97233-1058
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Country | US
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Telephone | 971-319-6171
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Fax |
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Provider Business Mailing Address
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Address Line | 12640 SE STARK ST
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City | PORTLAND
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State | OR
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Zip | 97233-1058
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Country | US
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Telephone | 971-319-6171
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Fax | 971-352-6916
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Authorized Official
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Title or Position | PRESIDENT
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Name | ROSANNA S HUNNICUTT
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Credential |
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Telephone | 818-235-9253
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 253Z00000X
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Taxonomy Name | In Home Supportive Care Agency
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License Number | 15-2334
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License Number State | OR
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