Provider Demographics
NPI:1225390495
Name:SEARLES WELLNESS LLC
Entity Type:Organization
Organization Name:SEARLES WELLNESS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:MONA
Authorized Official - Middle Name:
Authorized Official - Last Name:SEARLES
Authorized Official - Suffix:
Authorized Official - Credentials:ANP, LAC
Authorized Official - Phone:503-222-5005
Mailing Address - Street 1:0224 SW HAMILTON ST
Mailing Address - Street 2:SUITE 104
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97239-6418
Mailing Address - Country:US
Mailing Address - Phone:503-222-5005
Mailing Address - Fax:503-296-2482
Practice Address - Street 1:0224 SW HAMILTON ST
Practice Address - Street 2:SUITE 104
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97239-6418
Practice Address - Country:US
Practice Address - Phone:503-222-5005
Practice Address - Fax:503-296-2482
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-06-13
Last Update Date:2012-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORANP 083040868N3261Q00000X
ORLAC AC00866261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center