Provider Demographics
NPI:1689445447
Name:PADUA ADULT FOSTER HOME CARE, LLC
Entity Type:Organization
Organization Name:PADUA ADULT FOSTER HOME CARE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MERVIN
Authorized Official - Middle Name:
Authorized Official - Last Name:PADUA
Authorized Official - Suffix:
Authorized Official - Credentials:LPN
Authorized Official - Phone:503-206-6564
Mailing Address - Street 1:1827 SE 76TH AVE
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97215-3522
Mailing Address - Country:US
Mailing Address - Phone:503-206-6564
Mailing Address - Fax:503-206-6422
Practice Address - Street 1:1827 SE 76TH AVE
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97215-3522
Practice Address - Country:US
Practice Address - Phone:503-206-6564
Practice Address - Fax:503-206-6422
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-01-10
Last Update Date:2024-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253J00000XAgenciesFoster Care Agency