Provider Demographics
NPI:1235880543
Name:ESTREET OREGON, INC
Entity Type:Organization
Organization Name:ESTREET OREGON, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:DENISE
Authorized Official - Middle Name:
Authorized Official - Last Name:GRAHAM
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:909-630-2621
Mailing Address - Street 1:3620 SE POWELL BLVD STE 202
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97202-1880
Mailing Address - Country:US
Mailing Address - Phone:190-963-0262
Mailing Address - Fax:503-974-2003
Practice Address - Street 1:3620 SE POWELL BLVD STE 202
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97202-1880
Practice Address - Country:US
Practice Address - Phone:190-963-0262
Practice Address - Fax:503-974-2003
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-01-18
Last Update Date:2022-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care