Provider Demographics
NPI:1669884136
Name:NATURAL ESCAPE LLC
Entity type:Organization
Organization Name:NATURAL ESCAPE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PROVIDER
Authorized Official - Prefix:MR
Authorized Official - First Name:SHAUN
Authorized Official - Middle Name:THOMAS
Authorized Official - Last Name:COOPER
Authorized Official - Suffix:
Authorized Official - Credentials:LMT
Authorized Official - Phone:541-281-9530
Mailing Address - Street 1:1235 HILTON DR
Mailing Address - Street 2:
Mailing Address - City:KLAMATH FALLS
Mailing Address - State:OR
Mailing Address - Zip Code:97603-5254
Mailing Address - Country:US
Mailing Address - Phone:541-281-9530
Mailing Address - Fax:
Practice Address - Street 1:1235 HILTON DR
Practice Address - Street 2:
Practice Address - City:KLAMATH FALLS
Practice Address - State:OR
Practice Address - Zip Code:97603-5254
Practice Address - Country:US
Practice Address - Phone:541-281-9530
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-06-02
Last Update Date:2014-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR5485225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR5485OtherLMT NUMBER