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General NPI Number Information
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NPI Number | 1306372354
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Entity Type | Organization
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Legal Business Name | OR KREW, LLC
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Dates
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Enumeration Date | 05/11/2017
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Last Update Date | 05/11/2017
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Provider Practice Location Address
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Address Line | 19365 SW 65TH AVE STE 205
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City | TUALATIN
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State | OR
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Zip | 97062-9196
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Country | US
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Telephone | 503-855-4415
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 1267
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City | SPEARFISH
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State | SD
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Zip | 57783-7267
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Country | US
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Telephone | 605-716-1234
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Fax |
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Authorized Official
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Title or Position | CEO/PRESIDENT
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Name | LEZLIE ANNE SNOOZY-KAITFORS
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Credential |
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Telephone | 605-641-0433
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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 | 403051
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License Number State | OR
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