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General NPI Number Information
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NPI Number | 1417764077
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Entity Type | Organization
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Legal Business Name | ELDERLY AND DISABLED SERVICES
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Dates
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Enumeration Date | 12/16/2024
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Last Update Date | 02/19/2025
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Provider Practice Location Address
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Address Line | 995 SW 178TH PL
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City | BEAVERTON
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State | OR
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Zip | 97003-7504
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Country | US
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Telephone | 458-225-9358
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Fax |
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Provider Business Mailing Address
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Address Line | 3126 STATE ST STE 100
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City | MEDFORD
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State | OR
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Zip | 97504-8665
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Country | US
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Telephone | 458-225-9358
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Fax |
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Authorized Official
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Title or Position | OWNER/PROVIDER
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Name | MR. LARRY MICHAEL MCPHEE
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Credential |
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Telephone | 541-261-1991
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 320800000X
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Taxonomy Name | Mental Illness Community Based Residential Treatment Facility
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License Number |
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License Number State |
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