Provider Demographics
NPI:1093851776
Name:LANDERS, RICHARD ROSS I (QMHA)
Entity Type:Individual
Prefix:MR
First Name:RICHARD
Middle Name:ROSS
Last Name:LANDERS
Suffix:I
Gender:M
Credentials:QMHA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1820 NE 104TH AVE
Mailing Address - Street 2:61
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97220-3819
Mailing Address - Country:US
Mailing Address - Phone:503-830-1787
Mailing Address - Fax:
Practice Address - Street 1:326 SE 76TH AVE
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97215-1468
Practice Address - Country:US
Practice Address - Phone:503-255-3198
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered372600000XNursing Service Related ProvidersAdult Companion
Not Answered171M00000XOther Service ProvidersCase Manager/Care Coordinator