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General NPI Number Information
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NPI Number | 1932510682
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Entity Type | Organization
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Legal Business Name | KB LLC DBA SENIOR HELPERS OF PORTLAND
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Dates
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Enumeration Date | 05/15/2014
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Last Update Date | 05/15/2014
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Provider Practice Location Address
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Address Line | 407 NW 17TH AVE STE 16
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City | PORTLAND
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State | OR
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Zip | 97209-2249
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Country | US
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Telephone | 503-892-1189
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Fax |
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Provider Business Mailing Address
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Address Line | 25 NW 23RD PL STE 6
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City | PORTLAND
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State | OR
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Zip | 97210-5580
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Country | US
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Telephone | 503-892-1189
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Fax |
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Authorized Official
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Title or Position | OWNER/ADMINISTRATOR
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Name | MS. KELLI ANN BRADLEY
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Credential |
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Telephone | 503-381-9194
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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 | 15-2171
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License Number State | OR
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