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General NPI Number Information
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NPI Number | 1487152336
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Entity Type | Organization
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Legal Business Name | HD INDUSTRIES, LLC
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Dates
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Enumeration Date | 01/25/2018
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Last Update Date | 01/25/2018
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Provider Practice Location Address
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Address Line | 4850 SW SCHOLLS FERRY RD STE 302
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City | PORTLAND
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State | OR
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Zip | 97225-1696
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Country | US
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Telephone | 503-894-8796
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Fax | 503-914-1773
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Provider Business Mailing Address
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Address Line | 4850 SW SCHOLLS FERRY RD STE 302
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City | PORTLAND
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State | OR
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Zip | 97225-1696
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Country | US
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Telephone | 503-894-8796
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Fax | 503-914-1773
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Authorized Official
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Title or Position | DIRECTOR OF OPERATIONS
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Name | MR. CHARLES F. JOHNSON
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Credential |
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Telephone | 503-894-8796
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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 | 15-2315
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License Number State | OR
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