Provider Demographics
NPI:1538761671
Name:RESTORATIVE HEALTH CLINIC OF PORTLAND LLC
Entity type:Organization
Organization Name:RESTORATIVE HEALTH CLINIC OF PORTLAND LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MELANIE
Authorized Official - Middle Name:
Authorized Official - Last Name:STEIN
Authorized Official - Suffix:
Authorized Official - Credentials:ND
Authorized Official - Phone:503-780-6921
Mailing Address - Street 1:15657 SW 82ND AVE
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97224-7515
Mailing Address - Country:US
Mailing Address - Phone:503-780-6921
Mailing Address - Fax:
Practice Address - Street 1:6564 SE LAKE RD STE 100
Practice Address - Street 2:
Practice Address - City:MILWAUKIE
Practice Address - State:OR
Practice Address - Zip Code:97222-2238
Practice Address - Country:US
Practice Address - Phone:503-780-6921
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-11-13
Last Update Date:2020-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center