Provider Demographics
NPI:1275865602
Name:AUNTIE FAY AGENCY
Entity Type:Organization
Organization Name:AUNTIE FAY AGENCY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:FRANCES
Authorized Official - Middle Name:
Authorized Official - Last Name:BARNUM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:503-625-5245
Mailing Address - Street 1:16255 SW RAILROAD ST
Mailing Address - Street 2:
Mailing Address - City:SHERWOOD
Mailing Address - State:OR
Mailing Address - Zip Code:97140-9094
Mailing Address - Country:US
Mailing Address - Phone:503-625-5245
Mailing Address - Fax:
Practice Address - Street 1:16255 SW RAILROAD ST
Practice Address - Street 2:
Practice Address - City:SHERWOOD
Practice Address - State:OR
Practice Address - Zip Code:97140-9094
Practice Address - Country:US
Practice Address - Phone:503-625-5245
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-02-10
Last Update Date:2010-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR422240-6253Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care