Provider Demographics
NPI:1467714410
Name:JASPER VALLEY LP
Entity Type:Organization
Organization Name:JASPER VALLEY LP
Other - Org Name:HERITAGE HEARING AID CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:HEARING AID FITTER
Authorized Official - Prefix:MR
Authorized Official - First Name:DELMER
Authorized Official - Middle Name:
Authorized Official - Last Name:WARKENTIN
Authorized Official - Suffix:
Authorized Official - Credentials:MS
Authorized Official - Phone:503-518-3300
Mailing Address - Street 1:19142 S MOLALLA AVE STE C
Mailing Address - Street 2:
Mailing Address - City:OREGON CITY
Mailing Address - State:OR
Mailing Address - Zip Code:97045-7166
Mailing Address - Country:US
Mailing Address - Phone:503-518-3300
Mailing Address - Fax:503-518-3301
Practice Address - Street 1:19142 S MOLALLA AVE STE C
Practice Address - Street 2:
Practice Address - City:OREGON CITY
Practice Address - State:OR
Practice Address - Zip Code:97045-7166
Practice Address - Country:US
Practice Address - Phone:503-518-3300
Practice Address - Fax:503-518-3301
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:JASPER VALLEY LP
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2012-06-14
Last Update Date:2012-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument SpecialistGroup - Single Specialty