Provider Demographics
NPI:1629449392
Name:DECEMBER ROSES, LLC
Entity Type:Organization
Organization Name:DECEMBER ROSES, LLC
Other - Org Name:SENIOR HELPERS - METRO PORTLAND NORTH
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:JERRY
Authorized Official - Middle Name:NORMAN
Authorized Official - Last Name:HARRIS
Authorized Official - Suffix:JR
Authorized Official - Credentials:MHSA
Authorized Official - Phone:503-257-7787
Mailing Address - Street 1:12740 SE STARK ST
Mailing Address - Street 2:BUILDING F
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97233-1539
Mailing Address - Country:US
Mailing Address - Phone:503-257-7787
Mailing Address - Fax:888-748-7787
Practice Address - Street 1:12740 SE STARK ST
Practice Address - Street 2:BUILDING F
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97233-1539
Practice Address - Country:US
Practice Address - Phone:503-257-7787
Practice Address - Fax:888-748-7787
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-10-07
Last Update Date:2015-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR15-2265253Z00000X
WA60269071253Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR15-2265OtherOREGON HEALTH AUTHORITY PUBLIC HEALTH DIVISION
WA60269071OtherWASHINGTON STATE DEPARTMENT OF HEALTH