Provider Demographics
NPI:1720556079
Name:NORTHWEST IN HOME HEALTHCARE AGENCY
Entity Type:Organization
Organization Name:NORTHWEST IN HOME HEALTHCARE AGENCY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CO-OWNER/ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:GELGELU
Authorized Official - Middle Name:B
Authorized Official - Last Name:FELEMA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:503-250-4685
Mailing Address - Street 1:20 NE 157TH AVE
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97230-4823
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:20 NE 157TH AVE
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97230-4823
Practice Address - Country:US
Practice Address - Phone:503-250-4685
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-11-05
Last Update Date:2018-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR500718920Medicaid