Provider Demographics
NPI:1710629977
Name:PDX ELITE CARE INC
Entity Type:Organization
Organization Name:PDX ELITE CARE INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:HELENA
Authorized Official - Middle Name:A
Authorized Official - Last Name:LOPES-CULP
Authorized Official - Suffix:
Authorized Official - Credentials:CEO
Authorized Official - Phone:503-444-2466
Mailing Address - Street 1:PO BOX 1942
Mailing Address - Street 2:
Mailing Address - City:BEAVERTON
Mailing Address - State:OR
Mailing Address - Zip Code:97075-1942
Mailing Address - Country:US
Mailing Address - Phone:503-619-7295
Mailing Address - Fax:888-610-2910
Practice Address - Street 1:707 SW WASHINGTON ST STE 1100
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97205-3528
Practice Address - Country:US
Practice Address - Phone:503-444-2466
Practice Address - Fax:888-610-2910
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-04-08
Last Update Date:2022-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care