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General NPI Number Information
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NPI Number | 1033470133
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Entity Type | Organization
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Legal Business Name | AFFORDABLE CARE NW, LLC
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Dates
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Enumeration Date | 06/05/2012
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Last Update Date | 06/05/2012
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Provider Practice Location Address
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Address Line | 3609 SE 144TH AVE
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City | PORTLAND
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State | OR
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Zip | 97236-2728
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Country | US
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Telephone | 503-253-8458
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Fax | 503-257-0911
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Provider Business Mailing Address
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Address Line | 3609 SE 144TH AVE
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City | PORTLAND
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State | OR
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Zip | 97236-2728
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Country | US
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Telephone | 503-253-8458
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Fax | 503-257-0911
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Authorized Official
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Title or Position | DIRECTOR/PRESIDENT
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Name | MR. TOBY DAVID FORSBERG
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Credential |
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Telephone | 503-442-3990
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251E00000X
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Taxonomy Name | Home Health Agency
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License Number | 15-2249
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License Number State | OR
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Taxonomy #2
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Taxonomy Code | 253Z00000X
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Taxonomy Name | In Home Supportive Care Agency
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License Number | 15-2249
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License Number State | OR
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