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General NPI Number Information
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NPI Number | 1821810714
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Entity Type | Organization
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Legal Business Name | EASE MY WAY COMMUNITY CARE AGENCY LLC
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Dates
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Enumeration Date | 10/30/2024
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Last Update Date | 10/30/2024
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Provider Practice Location Address
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Address Line | 4506 SE BELMONT ST STE 103
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City | PORTLAND
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State | OR
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Zip | 97215-1658
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Country | US
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Telephone | 503-756-6123
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Fax |
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Provider Business Mailing Address
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Address Line | 1320 NW RIVERVIEW AVE
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City | GRESHAM
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State | OR
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Zip | 97030-4844
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Country | US
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Telephone | 503-756-6123
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Fax |
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Authorized Official
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Title or Position | OWNER AND ADMINISTRATOR
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Name | DR. J HILARY GBOTOE JR.
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Credential | PH.D., ED.D.
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Telephone | 503-756-6123
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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 |
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License Number State |
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