Provider Demographics
NPI:1710510094
Name:GRESHAM FAMILY CARE INC
Entity Type:Organization
Organization Name:GRESHAM FAMILY CARE INC
Other - Org Name:CARE PLUS YOU
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KEITH
Authorized Official - Middle Name:
Authorized Official - Last Name:HAINES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:503-213-6600
Mailing Address - Street 1:PO BOX 91
Mailing Address - Street 2:
Mailing Address - City:WEST LINN
Mailing Address - State:OR
Mailing Address - Zip Code:97068-0091
Mailing Address - Country:US
Mailing Address - Phone:503-213-6600
Mailing Address - Fax:971-350-7350
Practice Address - Street 1:1800 BLANKENSHIP RD STE 350
Practice Address - Street 2:
Practice Address - City:WEST LINN
Practice Address - State:OR
Practice Address - Zip Code:97068-4182
Practice Address - Country:US
Practice Address - Phone:503-213-6600
Practice Address - Fax:971-350-7350
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-02-14
Last Update Date:2020-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR500774621Medicaid