Organization
MT HOOD HOME CARE SERVICE LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
SHANNON CHRISTIE (ADMINISTRATOR)
(503) 826-8285
Entity
Organization
Contact information
Practice address
459 SW MAPLE ROAD, ESTACADA, OR 97023
(503) 826-8285
(971) 533-7952
Mailing address
PO BOX 1478, SANDY, OR 97055-1478
(503) 826-8285
(503) 668-9500
Taxonomy
Speciality
Code
Description
License number
State
253Z00000X
In Home Supportive Care Agency
Primary
—
—
3747A0650X
Attendant Care Provider
—
—
385H00000X
Respite Care
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
500741303
—
OR
Enumeration date
10/21/2019
Last updated
03/09/2023
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