Provider Demographics
NPI:1619621984
Name:SLMC, LLC
Entity Type:Organization
Organization Name:SLMC, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PROVIDER
Authorized Official - Prefix:
Authorized Official - First Name:SANDRA
Authorized Official - Middle Name:L
Authorized Official - Last Name:MORENO
Authorized Official - Suffix:
Authorized Official - Credentials:RD
Authorized Official - Phone:503-395-8890
Mailing Address - Street 1:1201 COURT ST NE STE 310A
Mailing Address - Street 2:
Mailing Address - City:SALEM
Mailing Address - State:OR
Mailing Address - Zip Code:97301-4182
Mailing Address - Country:US
Mailing Address - Phone:503-395-8890
Mailing Address - Fax:971-599-2155
Practice Address - Street 1:1201 COURT ST NE STE 310A
Practice Address - Street 2:
Practice Address - City:SALEM
Practice Address - State:OR
Practice Address - Zip Code:97301-4182
Practice Address - Country:US
Practice Address - Phone:503-395-8890
Practice Address - Fax:971-599-2155
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-02-07
Last Update Date:2022-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, RegisteredGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT12180539-4901OtherUTAH LICENSE
OR177171395OtherOREGON BUSINESS LICENSE
ORLD-D-10181188OtherOREGON LICENSE NUMBER
1790375020OtherNPI