Provider Demographics
NPI:1023356391
Name:TRUST HOME HEALTHCARE LLC
Entity type:Organization
Organization Name:TRUST HOME HEALTHCARE LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JAMAL
Authorized Official - Middle Name:M
Authorized Official - Last Name:DAR
Authorized Official - Suffix:SR
Authorized Official - Credentials:01,01,1978
Authorized Official - Phone:5034-475-8802
Mailing Address - Street 1:10706 SW CAPITOL HWY APT 58
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97219-6880
Mailing Address - Country:US
Mailing Address - Phone:503-475-8802
Mailing Address - Fax:
Practice Address - Street 1:10706 SW CAPITOL HWY APT 58
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97219-6880
Practice Address - Country:US
Practice Address - Phone:503-475-8802
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-01-22
Last Update Date:2013-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR46-1831014320900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320900000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities