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General NPI Number Information
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NPI Number | 1659548782
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Entity Type | Organization
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Legal Business Name | PROVIDENCE WEST HOME HEALTH
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Dates
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Enumeration Date | 05/08/2008
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Last Update Date | 05/08/2008
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Provider Practice Location Address
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Address Line | 3601 SW MURRAY BLVD STE. 40
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City | BEAVERTON
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State | OR
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Zip | 97005-2354
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Country | US
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Telephone | 503-216-2001
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Fax |
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Provider Business Mailing Address
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Address Line | 3601 SW MURRAY BLVD STE. 40
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City | BEAVERTON
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State | OR
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Zip | 97005-2354
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Country | US
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Telephone | 503-216-2001
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Fax |
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Authorized Official
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Title or Position | SUPERVISOR
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Name | SUSAN B. ALLEN
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Credential | PT
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Telephone | 503-574-9428
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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 | 2517
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License Number State | OR
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