Provider Demographics
NPI:1124191291
Name:HOUSE OF BLESSING
Entity Type:Organization
Organization Name:HOUSE OF BLESSING
Other - Org Name:HOUSE OF BLESSING
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:OVERSEER
Authorized Official - Prefix:DR
Authorized Official - First Name:CAROL
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:COOPER
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:503-393-6071
Mailing Address - Street 1:4131 RIVER RD N
Mailing Address - Street 2:
Mailing Address - City:KEIZER
Mailing Address - State:OR
Mailing Address - Zip Code:97303-5559
Mailing Address - Country:US
Mailing Address - Phone:503-393-6071
Mailing Address - Fax:
Practice Address - Street 1:4131 RIVER RD N
Practice Address - Street 2:
Practice Address - City:KEIZER
Practice Address - State:OR
Practice Address - Zip Code:97303-5559
Practice Address - Country:US
Practice Address - Phone:503-393-6071
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-16
Last Update Date:2014-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR27 2510261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR825613000OtherREGENCE BLUECROSS BLUESHI
ORR0000QGFKZMedicare ID - Type Unspecified