Provider Demographics
NPI:1437546082
Name:ADVANCED CARE HOME HEALTH, LLC.
Entity Type:Organization
Organization Name:ADVANCED CARE HOME HEALTH, LLC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR/DPS
Authorized Official - Prefix:MS
Authorized Official - First Name:EVELYN
Authorized Official - Middle Name:PARAS
Authorized Official - Last Name:DOMINGO
Authorized Official - Suffix:
Authorized Official - Credentials:RN, BSN
Authorized Official - Phone:971-254-9344
Mailing Address - Street 1:8835 SW CANYON LN
Mailing Address - Street 2:SUITE 208
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97225-3443
Mailing Address - Country:US
Mailing Address - Phone:971-254-9344
Mailing Address - Fax:971-254-9345
Practice Address - Street 1:8835 SW CANYON LN
Practice Address - Street 2:SUITE 208
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97225-3443
Practice Address - Country:US
Practice Address - Phone:971-254-9344
Practice Address - Fax:971-254-9345
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-04-22
Last Update Date:2015-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health