Provider Demographics
NPI:1235239203
Name:ACORN HEALING ARTS, LLC
Entity Type:Organization
Organization Name:ACORN HEALING ARTS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PROVIDER
Authorized Official - Prefix:MS
Authorized Official - First Name:MORI
Authorized Official - Middle Name:J
Authorized Official - Last Name:MONTAGNE
Authorized Official - Suffix:
Authorized Official - Credentials:NMNP
Authorized Official - Phone:503-245-1459
Mailing Address - Street 1:704 SE UMATILLA ST
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97202-6439
Mailing Address - Country:US
Mailing Address - Phone:503-234-2285
Mailing Address - Fax:
Practice Address - Street 1:1616 SW SUNSET BLVD
Practice Address - Street 2:SUITE E
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97239-2641
Practice Address - Country:US
Practice Address - Phone:503-245-1459
Practice Address - Fax:503-293-2023
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-22
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR092000262N5261Q00000X, 261QH0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Not Answered261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR0836369Medicaid
S28271Medicare UPIN
OR0836369Medicaid