Provider Demographics
NPI:1083016463
Name:YOGA UNION WELLNESS
Entity Type:Organization
Organization Name:YOGA UNION WELLNESS
Other - Org Name:PREMA HEALTH
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:KATE
Authorized Official - Middle Name:R
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:ND
Authorized Official - Phone:503-405-1158
Mailing Address - Street 1:2043 SE 50TH AVE
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97215-3852
Mailing Address - Country:US
Mailing Address - Phone:503-405-1158
Mailing Address - Fax:503-405-1158
Practice Address - Street 1:2043 SE 50TH AVE
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97215-3852
Practice Address - Country:US
Practice Address - Phone:503-405-1158
Practice Address - Fax:503-405-1158
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:YOGA UNION WELLNESS
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2014-09-17
Last Update Date:2014-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service