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General NPI Number Information
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NPI Number | 1598655474
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Entity Type | Organization
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Legal Business Name | JASON CARE HOME LLC
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Dates
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Enumeration Date | 07/03/2025
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Last Update Date | 07/03/2025
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Provider Practice Location Address
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Address Line | 9337 SE RAYMOND ST
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City | PORTLAND
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State | OR
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Zip | 97266-2747
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Country | US
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Telephone | 978-406-1540
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Fax |
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Provider Business Mailing Address
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Address Line | 9337 SE RAYMOND ST
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City | PORTLAND
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State | OR
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Zip | 97266-2747
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Country | US
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Telephone | 978-406-1540
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Fax |
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Authorized Official
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Title or Position | DIRECTOR
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Name | SAMUEL KINYANJUI
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Credential |
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Telephone | 978-406-1540
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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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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Taxonomy #2
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Taxonomy Code | 320900000X
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Taxonomy Name | Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
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License Number |
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License Number State |
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