Provider Demographics
NPI:1407249394
Name:HOLISTIC TREATMENT CENTER & SPA
Entity Type:Organization
Organization Name:HOLISTIC TREATMENT CENTER & SPA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:ZOHREH
Authorized Official - Middle Name:
Authorized Official - Last Name:PASHANDI
Authorized Official - Suffix:I
Authorized Official - Credentials:AC
Authorized Official - Phone:971-717-6882
Mailing Address - Street 1:2075 SW 1ST AVE STE 1C
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97201-5314
Mailing Address - Country:US
Mailing Address - Phone:503-953-3100
Mailing Address - Fax:
Practice Address - Street 1:2075 SW 1ST AVE STE 1C
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97201-5314
Practice Address - Country:US
Practice Address - Phone:503-953-3100
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:HOLISTIC ADULT DAY CENTER & SPA
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2015-03-17
Last Update Date:2015-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORAC158098261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center