Healthcare Provider Details

I. General information

NPI: 1689466302
Provider Name (Legal Business Name): ACACIA IN HOME CARE,LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/19/2025
Last Update Date: 05/19/2025
Certification Date: 05/19/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

255 NE 23RD ST
GRESHAM OR
97030-2721
US

IV. Provider business mailing address

255 NE 23RD ST
GRESHAM OR
97030-2721
US

V. Phone/Fax

Practice location:
  • Phone: 617-642-6470
  • Fax:
Mailing address:
  • Phone: 617-642-6470
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code320800000X
TaxonomyMental Illness Community Based Residential Treatment Facility
License Number
License Number State

VIII. Authorized Official

Name: IRENE NGEERA
Title or Position: OWNER
Credential:
Phone: 617-642-6470