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General NPI Number Information
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NPI Number | 1720940661
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Entity Type | Organization
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Legal Business Name | DJR 24HOURRS RESIDENTIAL LLC
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Dates
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Enumeration Date | 12/01/2025
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Last Update Date | 12/01/2025
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Provider Practice Location Address
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Address Line | 12109 SE HIGH CREEK RD 12109 SE HIGH CREEK RD
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City | HAPPY VALLEY
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State | OR
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Zip | 97086-4729
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Country | US
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Telephone | 336-995-2670
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Fax |
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Provider Business Mailing Address
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Address Line | 12109 SE HIGH CREEK RD
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City | HAPPY VALLEY
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State | OR
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Zip | 97086-4729
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Country | US
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Telephone | 336-995-2670
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Fax | 336-995-2670
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Authorized Official
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Title or Position | EXECUTIVE DIRECTOR
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Name | MR. ERMIAS MULUGETA TEKLE SR.
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Credential | RN
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Telephone | 336-995-2670
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 163WM0705X
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Taxonomy Name | Medical-Surgical Registered Nurse
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License Number |
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License Number State |
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