Provider Demographics
NPI:1477050326
Name:OREGON WELLNESS NETWORK
Entity type:Organization
Organization Name:OREGON WELLNESS NETWORK
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OPERATIONS MANAGER
Authorized Official - Prefix:DR
Authorized Official - First Name:LAVINIA
Authorized Official - Middle Name:
Authorized Official - Last Name:GOTO
Authorized Official - Suffix:
Authorized Official - Credentials:RN BSN MPH MBA DHA
Authorized Official - Phone:503-304-3408
Mailing Address - Street 1:3410 CHERRY AVE NE
Mailing Address - Street 2:
Mailing Address - City:KEIZER
Mailing Address - State:OR
Mailing Address - Zip Code:97303-4924
Mailing Address - Country:US
Mailing Address - Phone:503-304-3408
Mailing Address - Fax:503-304-3434
Practice Address - Street 1:2615 PORTLAND RD NE
Practice Address - Street 2:
Practice Address - City:SALEM
Practice Address - State:OR
Practice Address - Zip Code:97301-0124
Practice Address - Country:US
Practice Address - Phone:503-588-6303
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:OREGON ASSOCIATION OF AREA AGENCIES ON AGING & DISABILITIES
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2018-04-08
Last Update Date:2018-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health