Healthcare Provider Details

I. General information

NPI: 1548124936
Provider Name (Legal Business Name): BONTU KEFELE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/11/2025
Last Update Date: 12/11/2025
Certification Date: 12/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6409 SE JENNINGS AVE
MILWAUKIE OR
97267-6354
US

IV. Provider business mailing address

6409 SE JENNINGS AVE
MILWAUKIE OR
97267-6354
US

V. Phone/Fax

Practice location:
  • Phone: 503-464-6954
  • Fax: 503-652-6981
Mailing address:
  • Phone: 503-464-6954
  • Fax: 503-652-6981

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code311ZA0620X
TaxonomyAdult Care Home Facility
License Number6490725982
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: