Provider Demographics
NPI:1720694177
Name:PHILLIPS CARE SERVICES
Entity Type:Organization
Organization Name:PHILLIPS CARE SERVICES
Other - Org Name:COMFORCARE HOME CARE PORTLAND
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:MARISSA
Authorized Official - Middle Name:
Authorized Official - Last Name:PHILLIPS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:971-801-7606
Mailing Address - Street 1:6700 SW 105TH AVE STE 106
Mailing Address - Street 2:
Mailing Address - City:BEAVERTON
Mailing Address - State:OR
Mailing Address - Zip Code:97008-8831
Mailing Address - Country:US
Mailing Address - Phone:971-801-7606
Mailing Address - Fax:
Practice Address - Street 1:6700 SW 105TH AVE STE 106
Practice Address - Street 2:
Practice Address - City:BEAVERTON
Practice Address - State:OR
Practice Address - Zip Code:97008-8831
Practice Address - Country:US
Practice Address - Phone:971-801-7606
Practice Address - Fax:503-213-5999
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-09-21
Last Update Date:2024-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care
No251J00000XAgenciesNursing Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR528798Medicaid
OR528798Medicaid