Provider Demographics
NPI:1609177328
Name:SORRENTO CONSTRUCTION, INC
Entity Type:Organization
Organization Name:SORRENTO CONSTRUCTION, INC
Other - Org Name:OREGON RE-BATH
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:PHILLIP
Authorized Official - Middle Name:J
Authorized Official - Last Name:RENGEL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:503-643-9629
Mailing Address - Street 1:1345 SW 158TH AVE
Mailing Address - Street 2:
Mailing Address - City:BEAVERTON
Mailing Address - State:OR
Mailing Address - Zip Code:97006-6037
Mailing Address - Country:US
Mailing Address - Phone:503-643-9629
Mailing Address - Fax:503-643-9615
Practice Address - Street 1:1345 SW 158TH AVE
Practice Address - Street 2:
Practice Address - City:BEAVERTON
Practice Address - State:OR
Practice Address - Zip Code:97006-6037
Practice Address - Country:US
Practice Address - Phone:503-643-9629
Practice Address - Fax:503-643-9615
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-11-11
Last Update Date:2010-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR6884332BC3200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BC3200XSuppliersDurable Medical Equipment & Medical SuppliesCustomized Equipment