DEMETI GELGELU (NPI# 1801402946) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1801402946 |
| Entity Type | Individual |
| Full Name | DEMETI GELGELU |
| Practice Address |
2010 Sw 79th Ave Portland OR 97225-3806 |
| Practice Telephone | 9715064073 |
| Mailing Telephone | 9715064073 |
| Enumeration Date | 2020-09-22 |
| Last Update Date | 2020-09-22 |
| Gender Code | F |
| Is Sole Proprietor | Y |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 311ZA0620X |
Custodial Care Facility Specialization: Adult Care Home |
3024537281 | OR | Nursing & Custodial Care Facilities |
| Street Address |
2010 SW 79TH AVE |
| City | PORTLAND |
| State | OR |
| Zip Code | 97225-3806 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1508425034 | Gabrielle Gonzales | Behavior Technician | 1675 Sw Marlow Ave, Suite 200, Portland, OR 97225 | 2019-06-08 |
| 1558844555 | Tate Roseberry | Behavior Technician | 1675 Sw Marlow Avenue, Suite 200, Portland, OR 97225 | 2018-09-14 |
| 1982186300 | Dean Alan Hopkins | Registered Nurse | 11782 Sw Barnes Rd, Suite 300, Portland, OR 97225 | 2018-09-01 |
| 1316449168 | Surgery Center At St. Vincent, LLC | Clinic/Center | 9135 Sw Barnes Rd Ste 161, Portland, OR 97225 | 2018-03-07 |
| 1730606716 | Meghan Louise Lacy | Pediatrics | 11790 Sw Barnes Rd, Blg. A, Suite 140, Portland, OR 97225 | 2017-08-29 |
| 1841733433 | Tia Pugh | Occupational Therapist | 9155 S.w. Barnes Road, East Pavilion, Portland, OR 97225 | 2016-11-30 |
| 1295185585 | Stephanie Lynn Hart | Nurse Practitioner | 9155 Sw Barnes Rd Ste 240, Portland, OR 97225 | 2016-06-16 |
| 1962866244 | Bejian Shamloo | Chiropractor | 10200 Sw Eastridge St., Suite 235, Portland, OR 97225 | 2016-04-12 |
| 1992162630 | Robert Joseph Yoder | Psychologist | 9045 Barnes Rd, Portland, OR 97225 | 2016-01-26 |
| 1316303951 | Katie Herold | Chiropractor | 9315 Sw Morrison St, Portland, OR 97225 | 2016-01-12 |
| Find all providers in zip 97225 | ||||
| Taxonomy Code | 311ZA0620X |
| Grouping | Nursing & Custodial Care Facilities |
| Classification | Custodial Care Facility |
| Specialization | Adult Care Home |
| A custodial care facility providing supportive and personal care services to disabled and/or elderly individuals who cannot function independently in most areas of activity and need assistance and monitoring to enable them to remain in a home like environment. |
| Notes: [7/1/2003: new] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1801403910 | Baseti Gelgelu | Custodial Care Facility | 2055 Sw 79th Ave, Portland, OR 97225-3805 | 2020-09-23 |
| 1386122687 | Diana Elizabeth Gwinn | Custodial Care Facility | 16405 Ne Fargo Cir, Portland, OR 97230-5513 | 2018-07-30 |
| 1306212295 | Amer Filipovic | Custodial Care Facility | 2708 Se 111th Ave, Portland, OR 97266-1106 | 2015-08-14 |
| 1740410356 | Paradise Adult Foster Care Incorporated | Custodial Care Facility | 1356 Se 172nd Ave, Portland, OR 97233-4702 | 2009-07-16 |
| 1013153659 | Ileana Kerezsi | Custodial Care Facility | 3519 Se Cora Dr, Portland, OR 97202-3332 | 2009-01-04 |
| 1639291131 | Casa, Inc | Custodial Care Facility | 741 Warren Ave, Portland, ME 04103-1007 | 2007-04-04 |
| 1295043982 | Lifeworks Northwest | Custodial Care Facility | 14600 Nw Cornell Rd, Portland, OR 97229-5442 | 2010-09-16 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1447808100 | Remelita Loftin | Custodial Care Facility | 2297 Minnesota St, Eugene, OR 97402-6244 | 2019-08-27 |
| 1316506397 | Stephenie Jo Murdock | Custodial Care Facility | 2355 Baker St, Baker City, OR 97814-2541 | 2019-06-12 |
| 1346707296 | Dastu I Ahmat | Custodial Care Facility | 55 Nw 23rd St, Gresham, OR 97030-2640 | 2019-02-27 |
| 1558837781 | Larisa Kravchuk | Custodial Care Facility | 805 Fir Cone Dr Ne, Keizer, OR 97303-4328 | 2018-10-15 |
| 1376071464 | Mckenzie Living, Incorporated | Custodial Care Facility | 2621 Lone Oak Way, Eugene, OR 97404 | 2017-06-01 |
| 1598292997 | Gateway Assisted Living, Inc. | Custodial Care Facility | 611 N Cloverleaf Loop, Springfield, OR 97477-1188 | 2017-05-16 |
| 1841727617 | Gateway Gardens Assisted Living, Inc. | Custodial Care Facility | 178 Commons Dr, Eugene, OR 97401-8923 | 2017-05-11 |
| 1609314509 | Catherine Jensens Foster Home | Custodial Care Facility | 108 Ash Drive, Rogue River, OR 97537 | 2017-02-10 |
| 1932647211 | Lynn Marie Bartlett | Custodial Care Facility | 4286 Camellia Dr S, Salem, OR 97302-2710 | 2017-02-07 |
| 1568906477 | Radiant Care Afh 'llc' | Custodial Care Facility | 52 Nw Birch Ct, Warrenton, OR 97146 | 2016-12-12 |
| Find all providers with the same taxonomy | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.