Provider Demographics
NPI:1396259370
Name:GIFTED HANDS IN-HOME CARE AGENCY LLC
Entity type:Organization
Organization Name:GIFTED HANDS IN-HOME CARE AGENCY LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:ADMINSTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:DEFFO
Authorized Official - Middle Name:
Authorized Official - Last Name:MEBRAT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:971-678-0443
Mailing Address - Street 1:2770 SW BUTLER RD
Mailing Address - Street 2:
Mailing Address - City:GRESHAM
Mailing Address - State:OR
Mailing Address - Zip Code:97080-5495
Mailing Address - Country:US
Mailing Address - Phone:971-678-0443
Mailing Address - Fax:
Practice Address - Street 1:2770 SW BUTLER RD
Practice Address - Street 2:
Practice Address - City:GRESHAM
Practice Address - State:OR
Practice Address - Zip Code:97080-5495
Practice Address - Country:US
Practice Address - Phone:971-678-0443
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-11-28
Last Update Date:2017-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR15-2352253Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care