Provider Demographics
NPI:1306372354
Name:OR KREW, LLC
Entity Type:Organization
Organization Name:OR KREW, LLC
Other - Org Name:COMFORT KEEPERS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO/PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:LEZLIE
Authorized Official - Middle Name:ANNE
Authorized Official - Last Name:SNOOZY-KAITFORS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:605-641-0433
Mailing Address - Street 1:PO BOX 1267
Mailing Address - Street 2:
Mailing Address - City:SPEARFISH
Mailing Address - State:SD
Mailing Address - Zip Code:57783-7267
Mailing Address - Country:US
Mailing Address - Phone:605-716-1234
Mailing Address - Fax:
Practice Address - Street 1:19365 SW 65TH AVE STE 205
Practice Address - Street 2:
Practice Address - City:TUALATIN
Practice Address - State:OR
Practice Address - Zip Code:97062-9196
Practice Address - Country:US
Practice Address - Phone:503-855-4415
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-05-11
Last Update Date:2017-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR403051251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health