Provider Demographics
NPI:1740260801
Name:FIRST CALL HOME HEALTH AGENCY, LLC
Entity type:Organization
Organization Name:FIRST CALL HOME HEALTH AGENCY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:JACOB
Authorized Official - Middle Name:
Authorized Official - Last Name:MULLIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:503-371-4567
Mailing Address - Street 1:2608 CASCADIA INDUSTRIAL ST SE
Mailing Address - Street 2:
Mailing Address - City:SALEM
Mailing Address - State:OR
Mailing Address - Zip Code:97302-1372
Mailing Address - Country:US
Mailing Address - Phone:503-371-4567
Mailing Address - Fax:503-371-4569
Practice Address - Street 1:2608 CASCADIA INDUSTRIAL ST SE
Practice Address - Street 2:
Practice Address - City:SALEM
Practice Address - State:OR
Practice Address - Zip Code:97302-1372
Practice Address - Country:US
Practice Address - Phone:503-371-4567
Practice Address - Fax:503-371-4569
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-01-17
Last Update Date:2022-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR13 1375251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR100226Medicaid
520030001OtherFIRSTCHOICE 65 NUMBER
820030000OtherREGENCE BLUECROSS NUMBER
J456401OtherSECURE HORIZONS NUMBER