Provider Demographics
NPI:1437693264
Name:COLUMBIA BASIN BATH RENOVATION LLC
Entity Type:Organization
Organization Name:COLUMBIA BASIN BATH RENOVATION LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:SCOTT
Authorized Official - Middle Name:ALAN
Authorized Official - Last Name:MOORE
Authorized Official - Suffix:
Authorized Official - Credentials:CONTRACTOR
Authorized Official - Phone:541-701-5341
Mailing Address - Street 1:736 RANDALL ST
Mailing Address - Street 2:
Mailing Address - City:UMATILLA
Mailing Address - State:OR
Mailing Address - Zip Code:97882-9501
Mailing Address - Country:US
Mailing Address - Phone:541-701-5341
Mailing Address - Fax:
Practice Address - Street 1:736 RANDALL ST
Practice Address - Street 2:
Practice Address - City:UMATILLA
Practice Address - State:OR
Practice Address - Zip Code:97882-9501
Practice Address - Country:US
Practice Address - Phone:541-701-5341
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-12-13
Last Update Date:2016-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR195517171WH0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171WH0202XOther Service ProvidersContractorHome ModificationsGroup - Single Specialty