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General NPI Number Information
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NPI Number | 1154985752
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Entity Type | Organization
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Legal Business Name | DDCHEALTH, LLC
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Dates
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Enumeration Date | 04/29/2019
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Last Update Date | 10/12/2022
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Provider Practice Location Address
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Address Line | 1411 NW QUIMBY ST APT 515
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City | PORTLAND
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State | OR
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Zip | 97209
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Country | US
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Telephone | 503-496-7704
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Fax | 971-375-4420
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Provider Business Mailing Address
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Address Line | 3055 NW YEON AVE # 595
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City | PORTLAND
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State | OR
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Zip | 97210-1519
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Country | US
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Telephone | 503-496-7704
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Fax | 971-375-4420
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Authorized Official
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Title or Position | PROVIDER GENERAL MANAGER
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Name | MR. DUSTIN CARLSON
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Credential | FNP-BC
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Telephone | 503-944-9727
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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 |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 261QP2300X
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Taxonomy Name | Primary Care Clinic/Center
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License Number |
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License Number State |
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