Provider Demographics
NPI:1932680584
Name:HDE HOME CARE
Entity Type:Organization
Organization Name:HDE HOME CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:STAFFING COORDINATOR
Authorized Official - Prefix:
Authorized Official - First Name:BRYAN
Authorized Official - Middle Name:
Authorized Official - Last Name:BRADETICH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:503-686-9079
Mailing Address - Street 1:12655 SW CENTER ST STE 450
Mailing Address - Street 2:
Mailing Address - City:BEAVERTON
Mailing Address - State:OR
Mailing Address - Zip Code:97005-4726
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:12655 SW CENTER ST STE 450
Practice Address - Street 2:
Practice Address - City:BEAVERTON
Practice Address - State:OR
Practice Address - Zip Code:97005-4726
Practice Address - Country:US
Practice Address - Phone:503-686-9079
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-08-22
Last Update Date:2018-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR15-2229253Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care