Provider Demographics
NPI:1932510682
Name:KB LLC DBA SENIOR HELPERS OF PORTLAND
Entity Type:Organization
Organization Name:KB LLC DBA SENIOR HELPERS OF PORTLAND
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/ADMINISTRATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:KELLI
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:BRADLEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:503-381-9194
Mailing Address - Street 1:25 NW 23RD PL STE 6
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97210-5580
Mailing Address - Country:US
Mailing Address - Phone:503-892-1189
Mailing Address - Fax:
Practice Address - Street 1:407 NW 17TH AVE STE 16
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97209-2249
Practice Address - Country:US
Practice Address - Phone:503-892-1189
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-05-15
Last Update Date:2014-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR15-2171253Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care