Provider Demographics
NPI:1609026582
Name:ADVANCED MASSAGE CONCEPTS, LLC
Entity Type:Organization
Organization Name:ADVANCED MASSAGE CONCEPTS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:CAROL
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:CARNESE
Authorized Official - Suffix:
Authorized Official - Credentials:LMT
Authorized Official - Phone:503-241-4818
Mailing Address - Street 1:5125 SW MACADAM AVE
Mailing Address - Street 2:SUITE 145
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97239-3820
Mailing Address - Country:US
Mailing Address - Phone:503-241-4818
Mailing Address - Fax:503-241-7073
Practice Address - Street 1:5125 SW MACADAM AVE
Practice Address - Street 2:SUITE 145
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97239-3820
Practice Address - Country:US
Practice Address - Phone:503-241-4818
Practice Address - Fax:503-241-7073
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-09-26
Last Update Date:2008-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR12504261QH0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service