Provider Demographics
NPI:1407450281
Name:MESI ADULT FOSTER CAME HOME
Entity Type:Organization
Organization Name:MESI ADULT FOSTER CAME HOME
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROVIDER
Authorized Official - Prefix:
Authorized Official - First Name:MESERET
Authorized Official - Middle Name:ABEBE
Authorized Official - Last Name:KEBEDE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:678-602-0535
Mailing Address - Street 1:335 NW 338TH AVE
Mailing Address - Street 2:
Mailing Address - City:HILLSBORO
Mailing Address - State:OR
Mailing Address - Zip Code:97124-3643
Mailing Address - Country:US
Mailing Address - Phone:678-602-0535
Mailing Address - Fax:
Practice Address - Street 1:323 NW FREEMAN AVE
Practice Address - Street 2:
Practice Address - City:HILLSBORO
Practice Address - State:OR
Practice Address - Zip Code:97124-3739
Practice Address - Country:US
Practice Address - Phone:678-602-0535
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-11-23
Last Update Date:2020-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253J00000XAgenciesFoster Care Agency