Dastu I Ahmat
Individual provider Active NPI Adult Care Home Facility · Gresham, OR
NPI 1346707296 · NPPES record last updated Feb 27, 2019
Key facts
- NPI
- 1346707296
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Adult Care Home Facility 311ZA0620X
- License
- 11146 (OR)
- Practice address
- 55 NW 23Rd St
Gresham, OR 97030-2640 - Phone
- (503) 984-6216
- NPI assigned
- Feb 27, 2019
- Sex
- Female
- Sole proprietor
- Yes
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 11146 | OR | MD | Adult Care Home Facility |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Adult Care Home Facility | 311ZA0620X | 11146 | OR | Yes |
Addresses
Primary practice location
55 NW 23Rd St
Gresham, OR 97030-2640
Mailing address
55 NW 23Rd St
Gresham, OR 97030-2640
Phone (503) 984-6216
Other providers in Gresham, OR
- Dane Agost
- Tyani Aguiar
- Iratze Aguilar Martinez
- Brian Antonio Aguirre
- Bahar M Ahady
- Erica Elizabeth Akbari
- Glen Raymond Akers
- Stacia Akers
- Eric Ikaika Aki
- Talia Marie Thelen Akre
All providers in Gresham, OR · Adult Care Home Facility in Oregon
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Feb 27, 2019. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.