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General NPI Number Information
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NPI Number | 1003387663
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Entity Type | Organization
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Legal Business Name | ST. MARY OF BETHANY - THE HELPING HANDS - IN HOME CARE
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Dates
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Enumeration Date | 12/07/2018
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Last Update Date | 12/07/2018
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Provider Practice Location Address
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Address Line | 12655 SW CENTER ST STE 470
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City | BEAVERTON
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State | OR
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Zip | 97005-1690
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Country | US
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Telephone | 503-746-6190
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Fax | 503-746-6849
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Provider Business Mailing Address
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Address Line | 12655 SW CENTER ST STE 470
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City | BEAVERTON
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State | OR
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Zip | 97005-1690
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Country | US
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Telephone | 503-746-6190
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Fax | 503-746-6849
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | MR. CRISTITO SANTOS VELASCO
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Credential | ED. D
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Telephone | 541-992-0709
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251E00000X
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Taxonomy Name | Home Health Agency
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 253Z00000X
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Taxonomy Name | In Home Supportive Care Agency
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License Number |
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License Number State |
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