Provider Demographics
NPI:1275944019
Name:ANGELIC HEALING HANDS, INC.
Entity Type:Organization
Organization Name:ANGELIC HEALING HANDS, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ROD
Authorized Official - Middle Name:S
Authorized Official - Last Name:DUDLEY
Authorized Official - Suffix:
Authorized Official - Credentials:LMT
Authorized Official - Phone:503-644-6109
Mailing Address - Street 1:1225 NW MURRAY RD
Mailing Address - Street 2:SUITE 103
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97229-5552
Mailing Address - Country:US
Mailing Address - Phone:503-644-6109
Mailing Address - Fax:506-644-6109
Practice Address - Street 1:1225 NW MURRAY RD
Practice Address - Street 2:SUITE 103
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97229-5552
Practice Address - Country:US
Practice Address - Phone:503-644-6109
Practice Address - Fax:506-644-6109
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-05-14
Last Update Date:2014-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR6610174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR225700000XOtherMASSAGE THERAPY