Provider Demographics
NPI:1417348178
Name:SELECT HOME CARE PORTLAND, LLC
Entity Type:Organization
Organization Name:SELECT HOME CARE PORTLAND, LLC
Other - Org Name:SELECT HOME CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGING PARTNER
Authorized Official - Prefix:MR
Authorized Official - First Name:SCOTT
Authorized Official - Middle Name:T
Authorized Official - Last Name:WITT
Authorized Official - Suffix:
Authorized Official - Credentials:BSME, MBA
Authorized Official - Phone:503-488-5948
Mailing Address - Street 1:5319 SW WESTGATE DR
Mailing Address - Street 2:SUITE #240
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97221-2411
Mailing Address - Country:US
Mailing Address - Phone:503-488-5948
Mailing Address - Fax:503-715-0536
Practice Address - Street 1:5319 SW WESTGATE DR
Practice Address - Street 2:SUITE #240
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97221-2411
Practice Address - Country:US
Practice Address - Phone:503-488-5948
Practice Address - Fax:503-715-0536
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-02-16
Last Update Date:2016-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR15-2207253Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR500702118Medicaid