Provider Demographics
NPI:1548343486
Name:NORTHLAND HEARING CENTERS, INC
Entity type:Organization
Organization Name:NORTHLAND HEARING CENTERS, INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:BRADLEY
Authorized Official - Middle Name:P
Authorized Official - Last Name:FORD
Authorized Official - Suffix:
Authorized Official - Credentials:BS
Authorized Official - Phone:503-831-1000
Mailing Address - Street 1:289 E ELLENDALE AVE
Mailing Address - Street 2:SUITE 602
Mailing Address - City:DALLAS
Mailing Address - State:OR
Mailing Address - Zip Code:97338-1580
Mailing Address - Country:US
Mailing Address - Phone:503-831-1000
Mailing Address - Fax:503-831-1331
Practice Address - Street 1:289 E ELLENDALE AVE
Practice Address - Street 2:SUITE 602
Practice Address - City:DALLAS
Practice Address - State:OR
Practice Address - Zip Code:97338-1580
Practice Address - Country:US
Practice Address - Phone:503-831-1000
Practice Address - Fax:503-831-1331
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:NORTHLAND USLLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-10-23
Last Update Date:2008-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORHAS-P-817288332S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332S00000XSuppliersHearing Aid Equipment