Provider Demographics
NPI:1679610182
Name:DAVIS, ALTHEA
Entity type:Individual
Prefix:MS
First Name:ALTHEA
Middle Name:
Last Name:DAVIS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5624 NE 12TH AVE
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97211-4216
Mailing Address - Country:US
Mailing Address - Phone:503-281-1344
Mailing Address - Fax:
Practice Address - Street 1:5417 NE 25TH AVE
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97211-6211
Practice Address - Country:US
Practice Address - Phone:503-402-8118
Practice Address - Fax:503-282-6722
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered171M00000XOther Service ProvidersCase Manager/Care Coordinator
Not Answered372600000XNursing Service Related ProvidersAdult Companion