Individual ProviderJeremiah RichardsonCounselorBehavioral Health & Social Service ProvidersPractice Address11035 NE Sandy Blvd, Portland, OR 97220(503) 258-4200(503) 258-4555PECOS EnrollmentBased on the most recent information from CMS, provider Jeremiah Richardson is legally eligible to order and refer claims for Part B and DME services only.Part BMedicare Part BEnrolledHHAHome Health AgencyNot EnrolledDMEDurable Medical EquipmentEnrolledPMDPower Mobility DeviceNot EnrolledCMS last updated its PECOS records 2 days ago.Profile DetailsProvider ID1588062806Provider TypeIndividualFull NameRichardson, JeremiahGenderMaleSole ProprietorYesEnumeration Date12/18/2014Last Updated6/8/2018Contact InformationPractice LocationPractice Address11035 NE Sandy Blvd, Portland, OR 97220Phone(503) 258-4200FaxUnlisted FaxMailing LocationMailing Address1507 NE 122nd Ave, Portland, OR 97230-1911Phone(503) 258-4555FaxUnlisted FaxProvider TaxonomiesCodeDescriptionLicenseCode101YM0800XPrimaryDescriptionCounselorBehavioral Health & Social Service ProvidersLicenseUnlisted IssuerCode101YA0400XDescriptionCounselorBehavioral Health & Social Service ProvidersLicenseUnlisted Issuer