Provider Demographics
NPI:1346897287
Name:VANCOUVER HOME HEALTH CARE AGENCY LLC
Entity Type:Organization
Organization Name:VANCOUVER HOME HEALTH CARE AGENCY LLC
Other - Org Name:VANCOUVER HOME HEALTH CARE AGENCY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:RAYON
Authorized Official - Middle Name:
Authorized Official - Last Name:RAYMOND
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:360-975-7070
Mailing Address - Street 1:201 NE PARK PLAZA DR STE 200
Mailing Address - Street 2:
Mailing Address - City:VANCOUVER
Mailing Address - State:WA
Mailing Address - Zip Code:98684-5871
Mailing Address - Country:US
Mailing Address - Phone:360-975-7070
Mailing Address - Fax:360-975-4306
Practice Address - Street 1:8885 SW CANYON RD STE 123
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97225-3455
Practice Address - Country:US
Practice Address - Phone:503-360-0464
Practice Address - Fax:360-975-4306
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:VANCOUVER HOME HEALTH CARE AGENCY LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2019-08-26
Last Update Date:2023-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR1346897287OtherPRIVATE