Provider Demographics
NPI:1649904616
Name:ALSAN RESIDENTIAL SERVICE LLC
Entity type:Organization
Organization Name:ALSAN RESIDENTIAL SERVICE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:TOLIF
Authorized Official - Middle Name:B
Authorized Official - Last Name:GEMECHU
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:614-625-8806
Mailing Address - Street 1:3055 SE PERSONS CT
Mailing Address - Street 2:
Mailing Address - City:MILWAUKIE
Mailing Address - State:OR
Mailing Address - Zip Code:97267-4659
Mailing Address - Country:US
Mailing Address - Phone:503-305-7325
Mailing Address - Fax:503-974-9502
Practice Address - Street 1:3055 SE PERSONS CT
Practice Address - Street 2:
Practice Address - City:MILWAUKIE
Practice Address - State:OR
Practice Address - Zip Code:97267-4659
Practice Address - Country:US
Practice Address - Phone:503-305-7325
Practice Address - Fax:503-974-9502
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-07-14
Last Update Date:2022-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251J00000XAgenciesNursing Care