Provider Demographics
NPI:1306548326
Name:ST GROUP HOME CARE LLC
Entity type:Organization
Organization Name:ST GROUP HOME CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:NATALIIA
Authorized Official - Middle Name:
Authorized Official - Last Name:POPOVA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:917-972-9854
Mailing Address - Street 1:6020 SW ARCTIC DR
Mailing Address - Street 2:
Mailing Address - City:BEAVERTON
Mailing Address - State:OR
Mailing Address - Zip Code:97005-9404
Mailing Address - Country:US
Mailing Address - Phone:503-641-1575
Mailing Address - Fax:
Practice Address - Street 1:6020 SW ARCTIC DR
Practice Address - Street 2:
Practice Address - City:BEAVERTON
Practice Address - State:OR
Practice Address - Zip Code:97005-9404
Practice Address - Country:US
Practice Address - Phone:503-641-1575
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-03-21
Last Update Date:2024-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health