Provider Demographics
NPI:1912416694
Name:HANDS OF DAWN LLC
Entity Type:Organization
Organization Name:HANDS OF DAWN LLC
Other - Org Name:HANDS OF DAWN
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/LMT
Authorized Official - Prefix:
Authorized Official - First Name:DAWN
Authorized Official - Middle Name:M
Authorized Official - Last Name:JENSON
Authorized Official - Suffix:
Authorized Official - Credentials:LMT
Authorized Official - Phone:503-567-4263
Mailing Address - Street 1:250 PRINCETON AVE STE 207B
Mailing Address - Street 2:
Mailing Address - City:GLADSTONE
Mailing Address - State:OR
Mailing Address - Zip Code:97027-2566
Mailing Address - Country:US
Mailing Address - Phone:503-567-4263
Mailing Address - Fax:
Practice Address - Street 1:250 PRINCETON AVE STE 207B
Practice Address - Street 2:
Practice Address - City:GLADSTONE
Practice Address - State:OR
Practice Address - Zip Code:97027-2566
Practice Address - Country:US
Practice Address - Phone:503-567-4263
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-09-25
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR13546225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
1609131580OtherNPPES