Basic Information
| Provider Information | |||||||||
| NPI: | 1316585136 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | ABRITE OREGON LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 749 37TH AVE | ||||||||
| Address2: | |||||||||
| City: | SANTA CRUZ | ||||||||
| State: | CA | ||||||||
| PostalCode: | 950625124 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8443227483 | ||||||||
| FaxNumber: | 8883347021 | ||||||||
| Practice Location | |||||||||
| Address1: | 922 NW CIRCLE BLVD STE 160-151 | ||||||||
| Address2: | |||||||||
| City: | CORVALLIS | ||||||||
| State: | OR | ||||||||
| PostalCode: | 973301483 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8443227483 | ||||||||
| FaxNumber: | 8883347021 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/11/2019 | ||||||||
| LastUpdateDate: | 12/11/2019 | ||||||||
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| AuthorizedOfficialLastName: | PUMPHREY | ||||||||
| AuthorizedOfficialFirstName: | HEIDI | ||||||||
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| AuthorizedOfficialTitleorPosition: | INSURANCE COORDINATOR | ||||||||
| AuthorizedOfficialTelephone: | 8312341444 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | Y | ||||||||
| ParentOrganizationLBN: | ABRITE LLC | ||||||||
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| NPICertificationDate: | 12/11/2019 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 252Y00000X | Y | Agencies | Early Intervention Provider Agency |
No ID Information.