Provider Demographics
NPI:1598256281
Name:OREGON WELLNESS NETWORK LLC
Entity Type:Organization
Organization Name:OREGON WELLNESS NETWORK LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPERATIONS MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:LAVINIA
Authorized Official - Middle Name:
Authorized Official - Last Name:GOTO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:503-304-3408
Mailing Address - Street 1:3410 CHERRY AVE NE
Mailing Address - Street 2:
Mailing Address - City:KEIZER
Mailing Address - State:OR
Mailing Address - Zip Code:97303-4924
Mailing Address - Country:US
Mailing Address - Phone:503-304-3408
Mailing Address - Fax:
Practice Address - Street 1:3410 CHERRY AVE NE
Practice Address - Street 2:
Practice Address - City:KEIZER
Practice Address - State:OR
Practice Address - Zip Code:97303
Practice Address - Country:US
Practice Address - Phone:503-304-3655
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:OREGON ASSOCIATION OF AREA AGENCIES ON AGING & DISABILITIES
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2018-05-29
Last Update Date:2019-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty
No133V00000XDietary & Nutritional Service ProvidersDietitian, RegisteredGroup - Multi-Specialty
No163WD0400XNursing Service ProvidersRegistered NurseDiabetes EducatorGroup - Multi-Specialty
No251B00000XAgenciesCase ManagementGroup - Multi-Specialty
No261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy