Provider Demographics
NPI:1780427278
Name:B & B RESIDENTIAL CARE SERVICES, LLC
Entity type:Organization
Organization Name:B & B RESIDENTIAL CARE SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:BERHANU
Authorized Official - Middle Name:EJIGU
Authorized Official - Last Name:KEDEDA
Authorized Official - Suffix:
Authorized Official - Credentials:DNP
Authorized Official - Phone:678-793-8808
Mailing Address - Street 1:18514 SE WILMOT ST
Mailing Address - Street 2:
Mailing Address - City:MILWAUKIE
Mailing Address - State:OR
Mailing Address - Zip Code:97267-6426
Mailing Address - Country:US
Mailing Address - Phone:503-305-8884
Mailing Address - Fax:503-387-3092
Practice Address - Street 1:18514 SE WILMOT ST
Practice Address - Street 2:
Practice Address - City:MILWAUKIE
Practice Address - State:OR
Practice Address - Zip Code:97267-6426
Practice Address - Country:US
Practice Address - Phone:503-305-8884
Practice Address - Fax:503-387-3092
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-06-13
Last Update Date:2024-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes163W00000XNursing Service ProvidersRegistered NurseGroup - Single Specialty