Provider Demographics
NPI:1356820906
Name:CARSON HOLDINGS, LLC
Entity Type:Organization
Organization Name:CARSON HOLDINGS, LLC
Other - Org Name:HOMEWATCH CAREGIVERS OF PORTLAND
Other - Org Type:Doing Business As
Authorized Official - Title/Position:EXECUTIVE VICE PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ANDY
Authorized Official - Middle Name:
Authorized Official - Last Name:DELAHUNTY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:503-284-4440
Mailing Address - Street 1:3880 SE 8TH AVE STE 110
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97202-3772
Mailing Address - Country:US
Mailing Address - Phone:503-284-4440
Mailing Address - Fax:503-281-4612
Practice Address - Street 1:3880 SE 8TH AVE STE 110
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97202-3772
Practice Address - Country:US
Practice Address - Phone:503-284-4440
Practice Address - Fax:503-281-4612
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-08-13
Last Update Date:2021-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR15-2184253Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR500657085Medicaid
OR500655816Medicaid