| Organization Name: | STATESERV HOMECARE LLC |
| NPI Number: | 1013291657 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | CHRIS ROODE (VICE PRESIDENT) |
| Mailing Address: | 15717 Sw 74th Ave Suite 450 Tigard |
| State: | OR US |
| Postal Code: | 972248060 |
| Phone Number: | 5037292371 |
| Fax Number: | 5035989737 |
| NPI Enumeration Date: | 09/30/2011 |
| NPI Last Update Date: | 02/09/2012 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 332BX2000X |
| License Number: | NPC-0003526 |
| Healthcare Provider Taxonomy: (Secondary) | N |
| State: | OR |
| Taxonomy Type: | Suppliers |
| Taxonomy Classification: | Durable Medical Equipment & Medical Supplies |
| Taxonomy Specialization: | Oxygen Equipment & Supplies |
| Taxonomy Definition: | |