Provider Demographics
NPI:1902030224
Name:NORTHLAND HEARING CENTERS, INC.
Entity Type:Organization
Organization Name:NORTHLAND HEARING CENTERS, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:JEFF
Authorized Official - Middle Name:
Authorized Official - Last Name:LONGTAIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:503-257-6800
Mailing Address - Street 1:10570 SE WASHINGTON ST STE 202
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97216-2846
Mailing Address - Country:US
Mailing Address - Phone:503-257-6800
Mailing Address - Fax:
Practice Address - Street 1:7615 CASS ST
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68114-3623
Practice Address - Country:US
Practice Address - Phone:402-991-4327
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-05-14
Last Update Date:2009-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE226332S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332S00000XSuppliersHearing Aid Equipment