1093842288 NPI number — HOMEWOODS HEIGHTS LLC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1093842288 NPI number — HOMEWOODS HEIGHTS LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
HOMEWOODS HEIGHTS LLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
6
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1093842288
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
7700 NE PARKWAY DR
Provider Second Line Business Mailing Address:
SUITE 300
Provider Business Mailing Address City Name:
VANCOUVER
Provider Business Mailing Address State Name:
WA
Provider Business Mailing Address Postal Code:
98662-6648
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
360-735-7155
Provider Business Mailing Address Fax Number:
360-735-9416

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
17999 SE RIVER RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MILWAUKIE
Provider Business Practice Location Address State Name:
OR
Provider Business Practice Location Address Postal Code:
97267-5885
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
503-659-6600
Provider Business Practice Location Address Fax Number:
503-659-8193
Provider Enumeration Date:
02/27/2007

Additional Information

Authorized Official

Authorized Official Last Name:
VISLOCKY
Authorized Official First Name:
GREGORY
Authorized Official Middle Name:
J
Authorized Official Title or Position:
MANAGING MEMBER
Authorized Official Telephone Number:
360-735-7155

Provider Taxonomy Codes

  • Taxonomy code: 310400000X , registered in the state of OR ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 500024 , issued by the state of ( OR ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2025 www.npivalidator.com