Healthcare Provider Details

I. General information

NPI: 1881541100
Provider Name (Legal Business Name): SERAPHIM HEALTHCARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/16/2026
Last Update Date: 03/16/2026
Certification Date: 03/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4777 SW 11TH ST APT 223
GRESHAM OR
97080-4305
US

IV. Provider business mailing address

4777 SW 11TH ST APT 223
GRESHAM OR
97080-4305
US

V. Phone/Fax

Practice location:
  • Phone: 971-232-3132
  • Fax:
Mailing address:
  • Phone: 971-232-3132
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code320800000X
TaxonomyMental Illness Community Based Residential Treatment Facility
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code311ZA0620X
TaxonomyAdult Care Home Facility
License Number
License Number State

VIII. Authorized Official

Name: HUMPHREY NGUNJIRI WAMBUGU
Title or Position: CEO
Credential:
Phone: 774-232-1799