Provider Demographics
NPI:1811414170
Name:EPIDAVROS CENTER FOR WELLBEING
Entity Type:Organization
Organization Name:EPIDAVROS CENTER FOR WELLBEING
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:STUDIO MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:NICHELLE
Authorized Official - Middle Name:
Authorized Official - Last Name:SAWYER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:503-667-1500
Mailing Address - Street 1:223 E POWELL BLVD
Mailing Address - Street 2:
Mailing Address - City:GRESHAM
Mailing Address - State:OR
Mailing Address - Zip Code:97030-7605
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:223 E POWELL BLVD
Practice Address - Street 2:
Practice Address - City:GRESHAM
Practice Address - State:OR
Practice Address - Zip Code:97030-7605
Practice Address - Country:US
Practice Address - Phone:503-667-1500
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-08-28
Last Update Date:2017-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Multi-Specialty
No171100000XOther Service ProvidersAcupuncturistGroup - Multi-Specialty