MEDICARE: KING DAVID CARE HOME 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	320900000X	Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility

General Provider Information

NPI Number	:	1164355699
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	KING DAVID CARE HOME LLC

Provider Business Mailing Address
First Line	:	1883 NW RAVENWOOD DR
Second Line	:
City	:	ALBANY
State	:	OR
Zip	:	97321-1156
Country	:	US
Telephone Number	:	503-949-2030
Fax Number	:

Provider Business Practice Location Address
First Line	:	1883 NW RAVENWOOD DR
Second Line	:
City	:	ALBANY
State	:	OR
Zip	:	97321-1156
Country	:	US
Telephone Number	:	503-949-2030
Fax Number	:

Authorized Official
Title or Position	:	DIRECTOR
Name	:	MR. JOHN KARANJA
Credential	:
Telephone Number	:	503-949-2030

Provider Enumeration Date	:	06/04/2026
Last Update Date	:	06/04/2026

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Directions to “KING DAVID CARE HOME LLC ” Practice Location

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