Provider Demographics
NPI:1437862976
Name:TEAM WARD LLC
Entity Type:Organization
Organization Name:TEAM WARD LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:KELLY
Authorized Official - Middle Name:D
Authorized Official - Last Name:WARD
Authorized Official - Suffix:
Authorized Official - Credentials:LMT
Authorized Official - Phone:541-598-5592
Mailing Address - Street 1:335 NE 4TH ST
Mailing Address - Street 2:
Mailing Address - City:BEND
Mailing Address - State:OR
Mailing Address - Zip Code:97701-5162
Mailing Address - Country:US
Mailing Address - Phone:541-668-7506
Mailing Address - Fax:
Practice Address - Street 1:335 NE 4TH ST
Practice Address - Street 2:
Practice Address - City:BEND
Practice Address - State:OR
Practice Address - Zip Code:97701-5162
Practice Address - Country:US
Practice Address - Phone:541-668-7506
Practice Address - Fax:541-550-8541
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-12-29
Last Update Date:2022-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR27-562938OtherSECRETARY OF STATE