Healthcare Provider Details

I. General information

NPI: 1700421435
Provider Name (Legal Business Name): CAREHERE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/18/2019
Last Update Date: 11/18/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12106 NE AINSWORTH CIR STE 5
PORTLAND OR
97220-9001
US

IV. Provider business mailing address

5141 VIRGINIA WAY STE 350
BRENTWOOD TN
37027-2319
US

V. Phone/Fax

Practice location:
  • Phone: 615-221-5901
  • Fax:
Mailing address:
  • Phone: 615-221-5901
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QA0505X
TaxonomyAdult Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: MR. ERNEST CLEVENGER
Title or Position: PRESIDENT
Credential:
Phone: 615-221-5901