Provider Demographics
NPI:1154985752
Name:DDCHEALTH, LLC
Entity type:Organization
Organization Name:DDCHEALTH, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROVIDER GENERAL MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:DUSTIN
Authorized Official - Middle Name:
Authorized Official - Last Name:CARLSON
Authorized Official - Suffix:
Authorized Official - Credentials:FNP-BC
Authorized Official - Phone:503-944-9727
Mailing Address - Street 1:3055 NW YEON AVE # 595
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97210-1519
Mailing Address - Country:US
Mailing Address - Phone:503-496-7704
Mailing Address - Fax:971-375-4420
Practice Address - Street 1:1411 NW QUIMBY ST
Practice Address - Street 2:APT 515
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97209
Practice Address - Country:US
Practice Address - Phone:503-496-7704
Practice Address - Fax:971-375-4420
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-04-29
Last Update Date:2022-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
No251E00000XAgenciesHome Health