Provider Demographics
NPI:1114490406
Name:BENESTAR 713 INC
Entity Type:Organization
Organization Name:BENESTAR 713 INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:JOACHIM
Authorized Official - Middle Name:
Authorized Official - Last Name:CRETEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:503-515-1023
Mailing Address - Street 1:1211 NW GLISAN ST STE 205
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97209-3054
Mailing Address - Country:US
Mailing Address - Phone:503-515-1023
Mailing Address - Fax:
Practice Address - Street 1:1211 NW GLISAN ST STE 205
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97209-3054
Practice Address - Country:US
Practice Address - Phone:503-515-1023
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-01-09
Last Update Date:2019-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Single Specialty