Provider Demographics
NPI:1417764077
Name:ELDERLY AND DISABLED SERVICES
Entity type:Organization
Organization Name:ELDERLY AND DISABLED SERVICES
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER/PROVIDER
Authorized Official - Prefix:MR
Authorized Official - First Name:LARRY
Authorized Official - Middle Name:MICHAEL
Authorized Official - Last Name:MCPHEE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:541-261-1991
Mailing Address - Street 1:3126 STATE ST STE 100
Mailing Address - Street 2:
Mailing Address - City:MEDFORD
Mailing Address - State:OR
Mailing Address - Zip Code:97504-8665
Mailing Address - Country:US
Mailing Address - Phone:458-225-9358
Mailing Address - Fax:
Practice Address - Street 1:995 SW 178TH PL
Practice Address - Street 2:
Practice Address - City:BEAVERTON
Practice Address - State:OR
Practice Address - Zip Code:97003-7504
Practice Address - Country:US
Practice Address - Phone:458-225-9358
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ELDERLY AND DISABLED SERVICES
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2024-12-16
Last Update Date:2025-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320800000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Mental Illness