Provider Demographics
NPI:1376700682
Name:PORTRUSH, LLC
Entity Type:Organization
Organization Name:PORTRUSH, LLC
Other - Org Name:NURSING SOLUTIONS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHIEF FINANCIAL OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:RANDY
Authorized Official - Middle Name:
Authorized Official - Last Name:EDMUNDSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:903-532-1400
Mailing Address - Street 1:15255 N 40TH ST STE 141
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85032-4682
Mailing Address - Country:US
Mailing Address - Phone:602-331-1100
Mailing Address - Fax:
Practice Address - Street 1:15255 N 40TH ST STE 141
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85032-4682
Practice Address - Country:US
Practice Address - Phone:602-331-1100
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-22
Last Update Date:2021-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZRN045571251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health