Healthcare Provider Details

I. General information

NPI: 1396259370
Provider Name (Legal Business Name): GIFTED HANDS IN-HOME CARE AGENCY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/28/2017
Last Update Date: 11/28/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2770 SW BUTLER RD
GRESHAM OR
97080-5495
US

IV. Provider business mailing address

2770 SW BUTLER RD
GRESHAM OR
97080-5495
US

V. Phone/Fax

Practice location:
  • Phone: 971-678-0443
  • Fax:
Mailing address:
  • Phone: 971-678-0443
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number15-2352
License Number StateOR

VIII. Authorized Official

Name: MR. DEFFO MEBRAT
Title or Position: ADMINSTRATOR
Credential:
Phone: 971-678-0443