1497251516 NPI number — SCIENCE & SENSORY LLC

Table of content: (NPI 1497251516)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1497251516 NPI number — SCIENCE & SENSORY LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SCIENCE & SENSORY LLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
6
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1497251516
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/04/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4300 CHERRY AVE NE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
KEIZER
Provider Business Mailing Address State Name:
OR
Provider Business Mailing Address Postal Code:
97303
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
971-368-9030
Provider Business Mailing Address Fax Number:
503-336-1061

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4300 CHERRY AVE NE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
KEIZER
Provider Business Practice Location Address State Name:
OR
Provider Business Practice Location Address Postal Code:
97303
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
971-368-9030
Provider Business Practice Location Address Fax Number:
503-336-1061
Provider Enumeration Date:
04/05/2018

Additional Information

Authorized Official

Authorized Official Last Name:
SILVERMAN
Authorized Official First Name:
BETHANN
Authorized Official Middle Name:
MARIE
Authorized Official Title or Position:
CHIEF ADMINISTRATIVE OFFICER
Authorized Official Telephone Number:
971-368-9030

Provider Taxonomy Codes

  • Taxonomy code: 103K00000X , with the licence number:  ABA-B-10182972 , registered in the state of OR ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 500761682 , issued by the state of ( OR ) . This identifiers is of the category "MEDICAID".




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