Provider Demographics
NPI:1265664460
Name:AETNIA LLC
Entity Type:Organization
Organization Name:AETNIA LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:GENERAL PARTNER
Authorized Official - Prefix:MR
Authorized Official - First Name:JEREMY
Authorized Official - Middle Name:E
Authorized Official - Last Name:GILHOUSEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:503-347-9525
Mailing Address - Street 1:1203 4TH ST
Mailing Address - Street 2:
Mailing Address - City:TILLAMOOK
Mailing Address - State:OR
Mailing Address - Zip Code:97141-3419
Mailing Address - Country:US
Mailing Address - Phone:503-347-9525
Mailing Address - Fax:
Practice Address - Street 1:1203 4TH ST
Practice Address - Street 2:
Practice Address - City:TILLAMOOK
Practice Address - State:OR
Practice Address - Zip Code:97141-3419
Practice Address - Country:US
Practice Address - Phone:503-347-9525
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-08-20
Last Update Date:2009-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171R00000XOther Service ProvidersInterpreterGroup - Single Specialty