Healthcare Provider Details

I. General information

NPI: 1205770062
Provider Name (Legal Business Name): GIFTED IRIS HEALTHCARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/14/2026
Last Update Date: 04/14/2026
Certification Date: 04/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15648 SE 114TH AVE STE 206
CLACKAMAS OR
97015-9033
US

IV. Provider business mailing address

15648 SE 114TH AVE STE 206
CLACKAMAS OR
97015-9033
US

V. Phone/Fax

Practice location:
  • Phone: 503-473-2347
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251J00000X
TaxonomyNursing Care Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State

VIII. Authorized Official

Name: ANDREW MEBRAT
Title or Position: ADMINISTRATOR
Credential:
Phone: 503-473-2347