MEDICARE: STAND BY ME 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	253Z00000X	In Home Supportive Care Agency

General Provider Information

NPI Number	:	1205424298
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	STAND BY ME LLC

Provider Business Mailing Address
First Line	:	9144 SW ARAPAHO RD
Second Line	:
City	:	TUALATIN
State	:	OR
Zip	:	97062-6339
Country	:	US
Telephone Number	:	971-219-9286
Fax Number	:

Provider Business Practice Location Address
First Line	:	9144 SW ARAPAHO RD
Second Line	:
City	:	TUALATIN
State	:	OR
Zip	:	97062-6339
Country	:	US
Telephone Number	:	971-219-9286
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	KATHERINE PRITCHARD
Credential	:
Telephone Number	:	503-307-3660

Provider Enumeration Date	:	01/05/2021
Last Update Date	:	01/05/2021

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Directions to “STAND BY ME LLC ” Practice Location

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