MEDICARE: COLUMBIA CARE LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	251E00000X	Home Health Agency	IHC 15-2144	OR

General Provider Information

NPI Number	:	1154588093
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	COLUMBIA CARE LLC

Provider Business Mailing Address
First Line	:	12847 NW CORNELL RD
Second Line	:
City	:	PORTLAND
State	:	OR
Zip	:	97229-5813
Country	:	US
Telephone Number	:	503-574-3674
Fax Number	:

Provider Business Practice Location Address
First Line	:	12847 NW CORNELL RD
Second Line	:
City	:	PORTLAND
State	:	OR
Zip	:	97229-5813
Country	:	US
Telephone Number	:	503-574-3674
Fax Number	:

Authorized Official
Title or Position	:	MANAGING DIRECTOR
Name	:	MR. ROB MACNAUGHTON
Credential	:
Telephone Number	:	503-574-3674

Provider Enumeration Date	:	05/19/2008
Last Update Date	:	05/19/2008

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