Provider Demographics
NPI:1710468780
Name:SPA SASSE LLC
Entity Type:Organization
Organization Name:SPA SASSE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:SARA
Authorized Official - Middle Name:
Authorized Official - Last Name:SASSE
Authorized Official - Suffix:
Authorized Official - Credentials:LMT
Authorized Official - Phone:808-283-6669
Mailing Address - Street 1:PO BOX 22266
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97269-2266
Mailing Address - Country:US
Mailing Address - Phone:503-228-8266
Mailing Address - Fax:
Practice Address - Street 1:630 SW ALDER ST
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97205-3616
Practice Address - Country:US
Practice Address - Phone:503-228-8266
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-08-27
Last Update Date:2018-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center