Provider Demographics
NPI:1427561182
Name:HAVEN STONE MASSAGE
Entity Type:Organization
Organization Name:HAVEN STONE MASSAGE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:HILARY
Authorized Official - Middle Name:VANESSA
Authorized Official - Last Name:BRAMLEY
Authorized Official - Suffix:
Authorized Official - Credentials:LMT
Authorized Official - Phone:503-430-4200
Mailing Address - Street 1:215 W ILLINOIS ST
Mailing Address - Street 2:
Mailing Address - City:NEWBERG
Mailing Address - State:OR
Mailing Address - Zip Code:97132-1607
Mailing Address - Country:US
Mailing Address - Phone:503-430-4200
Mailing Address - Fax:
Practice Address - Street 1:1530 E 1ST ST
Practice Address - Street 2:
Practice Address - City:NEWBERG
Practice Address - State:OR
Practice Address - Zip Code:97132-3237
Practice Address - Country:US
Practice Address - Phone:503-430-4200
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-11-15
Last Update Date:2017-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR13000OtherOREGON BOARD OF MASSAGE THERAPY