Healthcare Provider Details

I. General information

NPI: 1407464852
Provider Name (Legal Business Name): HOME HEALTH HEROES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/21/2020
Last Update Date: 07/27/2020
Certification Date: 07/27/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1107 NW 15TH ST APT 214
GRESHAM OR
97030-4899
US

IV. Provider business mailing address

1107 NW 15TH ST APT 214
GRESHAM OR
97030-4899
US

V. Phone/Fax

Practice location:
  • Phone: 805-804-0443
  • Fax:
Mailing address:
  • Phone: 805-804-0443
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health 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: MICHELLE SWANSON
Title or Position: OWNER
Credential:
Phone: 805-804-0443