Provider Demographics
NPI:1639864333
Name:DESCHUTES LASER THERAPY. LLC
Entity Type:Organization
Organization Name:DESCHUTES LASER THERAPY. LLC
Other - Org Name:DESCHUTES LASER AND HEALING THERAPIES, LLC
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CARLA
Authorized Official - Middle Name:
Authorized Official - Last Name:ELMS
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:541-610-8159
Mailing Address - Street 1:2581 NW LEXIE LN
Mailing Address - Street 2:
Mailing Address - City:REDMOND
Mailing Address - State:OR
Mailing Address - Zip Code:97756-6858
Mailing Address - Country:US
Mailing Address - Phone:541-610-8159
Mailing Address - Fax:
Practice Address - Street 1:707 SW 9TH ST
Practice Address - Street 2:
Practice Address - City:REDMOND
Practice Address - State:OR
Practice Address - Zip Code:97756-2726
Practice Address - Country:US
Practice Address - Phone:541-610-1815
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-04-07
Last Update Date:2023-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes163WW0000XNursing Service ProvidersRegistered NurseWound CareGroup - Multi-Specialty
No163W00000XNursing Service ProvidersRegistered NurseGroup - Multi-Specialty
No163WI0500XNursing Service ProvidersRegistered NurseInfusion TherapyGroup - Multi-Specialty
No163WP0000XNursing Service ProvidersRegistered NursePain ManagementGroup - Multi-Specialty
No163WX1500XNursing Service ProvidersRegistered NurseOstomy CareGroup - Multi-Specialty