Provider Demographics
NPI:1720643786
Name:THE FLOAT SHOPPE, INC.
Entity Type:Organization
Organization Name:THE FLOAT SHOPPE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CO-FOUNDER/PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:SANDRA
Authorized Official - Middle Name:FREEDING
Authorized Official - Last Name:CALM
Authorized Official - Suffix:
Authorized Official - Credentials:RN, MS
Authorized Official - Phone:503-706-3386
Mailing Address - Street 1:1515 NW 23RD AVE
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97210-2617
Mailing Address - Country:US
Mailing Address - Phone:503-706-3386
Mailing Address - Fax:
Practice Address - Street 1:1515 NW 23RD AVE
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97210-2617
Practice Address - Country:US
Practice Address - Phone:503-706-3386
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-05-06
Last Update Date:2019-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center