Provider Demographics
NPI:1003387663
Name:ST. MARY OF BETHANY - THE HELPING HANDS - IN HOME CARE
Entity Type:Organization
Organization Name:ST. MARY OF BETHANY - THE HELPING HANDS - IN HOME CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:CRISTITO
Authorized Official - Middle Name:SANTOS
Authorized Official - Last Name:VELASCO
Authorized Official - Suffix:
Authorized Official - Credentials:ED D
Authorized Official - Phone:541-992-0709
Mailing Address - Street 1:12655 SW CENTER ST STE 470
Mailing Address - Street 2:
Mailing Address - City:BEAVERTON
Mailing Address - State:OR
Mailing Address - Zip Code:97005-1690
Mailing Address - Country:US
Mailing Address - Phone:503-746-6190
Mailing Address - Fax:503-746-6849
Practice Address - Street 1:12655 SW CENTER ST STE 470
Practice Address - Street 2:
Practice Address - City:BEAVERTON
Practice Address - State:OR
Practice Address - Zip Code:97005-1690
Practice Address - Country:US
Practice Address - Phone:503-746-6190
Practice Address - Fax:503-746-6849
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-12-07
Last Update Date:2018-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care
No251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR152372Medicaid