Provider Demographics
NPI:1710153044
Name:COACHESLIBRARY
Entity Type:Organization
Organization Name:COACHESLIBRARY
Other - Org Name:KATHLEEN NAJDEK
Other - Org Type:Doing Business As
Authorized Official - Title/Position:REGISTERED NURSE
Authorized Official - Prefix:
Authorized Official - First Name:KATHLEEN
Authorized Official - Middle Name:
Authorized Official - Last Name:NAJDEK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:503-347-8042
Mailing Address - Street 1:PO BOX 23933
Mailing Address - Street 2:
Mailing Address - City:TIGARD
Mailing Address - State:OR
Mailing Address - Zip Code:97281-3933
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:14103 SW WAGONER PL
Practice Address - Street 2:
Practice Address - City:TIGARD
Practice Address - State:OR
Practice Address - Zip Code:97224-1796
Practice Address - Country:US
Practice Address - Phone:503-347-8042
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:NOT A SUB PART
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-05-06
Last Update Date:2008-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR076036037261QS1000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QS1000XAmbulatory Health Care FacilitiesClinic/CenterStudent Health