Provider Demographics
NPI:1952522948
Name:KLAHHANE ENDEAVORS
Entity Type:Organization
Organization Name:KLAHHANE ENDEAVORS
Other - Org Name:RENAISSANCE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:LYNN
Authorized Official - Middle Name:D
Authorized Official - Last Name:KEENAN
Authorized Official - Suffix:
Authorized Official - Credentials:PHD, LMP
Authorized Official - Phone:360-565-1199
Mailing Address - Street 1:215 KLAHANNE RIDGE DR
Mailing Address - Street 2:
Mailing Address - City:PORT ANGELES
Mailing Address - State:WA
Mailing Address - Zip Code:98362-8226
Mailing Address - Country:US
Mailing Address - Phone:360-565-1199
Mailing Address - Fax:360-565-1166
Practice Address - Street 1:401 E FRONT ST
Practice Address - Street 2:
Practice Address - City:PORT ANGELES
Practice Address - State:WA
Practice Address - Zip Code:98362-3113
Practice Address - Country:US
Practice Address - Phone:360-565-1199
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-01
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA00021304174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty