Provider Demographics
NPI:1619711801
Name:ARBORA COLLECTIVE LLC
Entity type:Organization
Organization Name:ARBORA COLLECTIVE LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:ELISABETH
Authorized Official - Middle Name:
Authorized Official - Last Name:HERNANDEZ
Authorized Official - Suffix:
Authorized Official - Credentials:MSN, APRN-CNS, CCM
Authorized Official - Phone:541-600-0878
Mailing Address - Street 1:935 WILLAGILLESPIE RD STE A
Mailing Address - Street 2:
Mailing Address - City:EUGENE
Mailing Address - State:OR
Mailing Address - Zip Code:97401-2106
Mailing Address - Country:US
Mailing Address - Phone:541-600-0878
Mailing Address - Fax:541-854-4000
Practice Address - Street 1:935 WILLAGILLESPIE RD STE A
Practice Address - Street 2:
Practice Address - City:EUGENE
Practice Address - State:OR
Practice Address - Zip Code:97401-2106
Practice Address - Country:US
Practice Address - Phone:541-600-0878
Practice Address - Fax:541-854-4000
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ARBORA MEDICAL SPA
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2024-06-21
Last Update Date:2024-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
No251B00000XAgenciesCase Management
No305S00000XManaged Care OrganizationsPoint of Service
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR1871222430Medicaid