Healthcare Provider Details

I. General information

NPI: 1225918576
Provider Name (Legal Business Name): BETTY TRANSPORTATION LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/06/2025
Last Update Date: 09/06/2025
Certification Date: 09/06/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

760 NE 24TH ST
GRESHAM OR
97030-2867
US

IV. Provider business mailing address

760 NE 24TH ST
GRESHAM OR
97030-2867
US

V. Phone/Fax

Practice location:
  • Phone: 720-429-2426
  • Fax:
Mailing address:
  • Phone: 720-429-2426
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code343900000X
TaxonomyNon-emergency Medical Transport (VAN)
License Number
License Number State

VIII. Authorized Official

Name: BERAKI TEWELDE
Title or Position: OWNER
Credential:
Phone: 720-429-2426