Provider Demographics
NPI:1477832053
Name:FIRST ADVENT MISSION
Entity Type:Organization
Organization Name:FIRST ADVENT MISSION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:IN HOME SERVICES
Authorized Official - Prefix:
Authorized Official - First Name:SHARON
Authorized Official - Middle Name:LEE
Authorized Official - Last Name:SHIELDS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:541-702-2204
Mailing Address - Street 1:1055 N 5TH ST UNIT 93
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:OR
Mailing Address - Zip Code:97530-9654
Mailing Address - Country:US
Mailing Address - Phone:541-702-2204
Mailing Address - Fax:
Practice Address - Street 1:1055 N 5TH ST UNIT 93
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:OR
Practice Address - Zip Code:97530-9654
Practice Address - Country:US
Practice Address - Phone:541-702-2204
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-08-12
Last Update Date:2011-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes372500000XNursing Service Related ProvidersChore ProviderGroup - Multi-Specialty
No374U00000XNursing Service Related ProvidersHome Health AideGroup - Multi-Specialty