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Contact Information

ADVANTAGE HARBOR QALICB, LLC
442 SW UMATILLA AVE STE 200
REDMOND, OR97756-7039
 Phone: 541-504-3900
 Fax:
 Website:
 

Specialty

Taxonomy Code Specialty Code Provider Type

General Practice

1223G0001X
Indicates primary specialty

NPI Profile & details for ADVANTAGE HARBOR QALICB, LLC

NPI # 1316368608
LBN Legal business name ADVANTAGE HARBOR QALICB, LLC
Authorized official JEANNE DYSERT - (EXEC VP OF OPERATIONS)
Entity Organization
Organization subpart 1 No
Enumeration date 01/03/2014
Last updated 01/03/2014 - About 12 years ago
Identifiers
OR License # D4459
1 Some organization health care providers are made up of components that furnish different types of health care or have separate physical locations where health care is furnished. These components and physical locations are not themselves legal entities, but are part of the organization health care provider (which is a legal entity). A covered organization provider may decide that its subparts (if it has any) should have their own NPI numbers. If a subpart conducts any HIPAA standard transactions on its own (e.g., separately from its parent), it must obtain its own NPI number.

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