Provider Demographics
NPI:1366759599
Name:1STSENIORCARE LLC
Entity type:Organization
Organization Name:1STSENIORCARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT AND CFO
Authorized Official - Prefix:MRS
Authorized Official - First Name:CARRIE
Authorized Official - Middle Name:L
Authorized Official - Last Name:TABOR
Authorized Official - Suffix:
Authorized Official - Credentials:MS
Authorized Official - Phone:503-590-5928
Mailing Address - Street 1:16387 SW ONEILL CT
Mailing Address - Street 2:
Mailing Address - City:TIGARD
Mailing Address - State:OR
Mailing Address - Zip Code:97223-5704
Mailing Address - Country:US
Mailing Address - Phone:503-590-5928
Mailing Address - Fax:602-914-5082
Practice Address - Street 1:16387 SW ONEILL CT
Practice Address - Street 2:
Practice Address - City:TIGARD
Practice Address - State:OR
Practice Address - Zip Code:97223-5704
Practice Address - Country:US
Practice Address - Phone:503-590-5928
Practice Address - Fax:602-914-5082
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-09-09
Last Update Date:2010-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR099071-97332B00000X, 332BC3200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BC3200XSuppliersDurable Medical Equipment & Medical SuppliesCustomized Equipment
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies