MEDICARE: DEVOTIONAL CARE HOME HEALTH AGENCY

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

General Provider Information

NPI Number	:	1669055869
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DEVOTIONAL CARE HOME HEALTH AGENCY

Provider Business Mailing Address
First Line	:	650 NE HOLLADAY ST STE 1600
Second Line	:
City	:	PORTLAND
State	:	OR
Zip	:	97232-2035
Country	:	US
Telephone Number	:	503-863-9687
Fax Number	:	503-444-3301

Provider Business Practice Location Address
First Line	:	650 NE HOLLADAY ST STE 1600
Second Line	:
City	:	PORTLAND
State	:	OR
Zip	:	97232-2035
Country	:	US
Telephone Number	:	866-429-8880
Fax Number	:	503-444-3301

Authorized Official
Title or Position	:	MANAGER
Name	:	KEVINA KEMP
Credential	:
Telephone Number	:	503-863-9687

Provider Enumeration Date	:	05/04/2021
Last Update Date	:	05/04/2021

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