Healthcare Provider Details

I. General information

NPI: 1790678530
Provider Name (Legal Business Name): WHITEROSE CARE HOMES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/30/2025
Last Update Date: 05/30/2025
Certification Date: 05/30/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2206 NE KELLY AVE
GRESHAM OR
97030-2844
US

IV. Provider business mailing address

2206 NE KELLY AVE
GRESHAM OR
97030-2844
US

V. Phone/Fax

Practice location:
  • Phone: 774-253-2755
  • Fax:
Mailing address:
  • Phone: 774-253-2755
  • 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: JOYCE MAINA
Title or Position: EXECUTIVE DIRECTOR
Credential: RN/BSN
Phone: 774-253-2755