Provider Demographics
NPI:1194230870
Name:DIRECT NURSING SERVICES LLC
Entity Type:Organization
Organization Name:DIRECT NURSING SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:
Authorized Official - Last Name:TANEOUS
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:503-720-3006
Mailing Address - Street 1:PO BOX 1607
Mailing Address - Street 2:
Mailing Address - City:BEAVERTON
Mailing Address - State:OR
Mailing Address - Zip Code:97075-1607
Mailing Address - Country:US
Mailing Address - Phone:503-720-3006
Mailing Address - Fax:
Practice Address - Street 1:8040 SW GREENHOUSE LN
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97225-3869
Practice Address - Country:US
Practice Address - Phone:503-720-3006
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-12-04
Last Update Date:2017-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
251E00000X
OR15-2355251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health