Provider Demographics
NPI:1295402634
Name:SANDARE LLC
Entity Type:Organization
Organization Name:SANDARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SANDRA
Authorized Official - Middle Name:
Authorized Official - Last Name:LARE
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:503-708-2165
Mailing Address - Street 1:690 SW STEPHENSON ST
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97219-7899
Mailing Address - Country:US
Mailing Address - Phone:503-708-2165
Mailing Address - Fax:
Practice Address - Street 1:690 SW STEPHENSON ST
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97219-7899
Practice Address - Country:US
Practice Address - Phone:503-708-2165
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-08-24
Last Update Date:2021-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty
No2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent PsychiatryGroup - Single Specialty