Organization
1STSENIORCARE LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. CARRIE L TABOR MS (PRESIDENT AND CFO)
(503) 590-5928
Entity
Organization
Contact information
Practice address
16387 SW ONEILL CT, TIGARD, OR 97223-5704
(503) 590-5928
(602) 914-5082
Mailing address
16387 SW ONEILL CT, TIGARD, OR 97223-5704
(503) 590-5928
(602) 914-5082
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
099071-97
OR
332BC3200X
Customized Equipment (DME)
Primary
099071-97
OR
Other
Enumeration date
09/09/2010
Last updated
09/09/2010
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