Provider Demographics
NPI:1104533223
Name:CASCADE REGENERATIVE MEDICINE LLC
Entity type:Organization
Organization Name:CASCADE REGENERATIVE MEDICINE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:RIAN
Authorized Official - Middle Name:NIGHTINGALE
Authorized Official - Last Name:SHAH
Authorized Official - Suffix:
Authorized Official - Credentials:ND
Authorized Official - Phone:425-391-5270
Mailing Address - Street 1:450 NW GILMAN BLVD STE 201
Mailing Address - Street 2:
Mailing Address - City:ISSAQUAH
Mailing Address - State:WA
Mailing Address - Zip Code:98027-2722
Mailing Address - Country:US
Mailing Address - Phone:425-391-5270
Mailing Address - Fax:425-391-8091
Practice Address - Street 1:450 NW GILMAN BLVD STE 200
Practice Address - Street 2:
Practice Address - City:ISSAQUAH
Practice Address - State:WA
Practice Address - Zip Code:98027-2483
Practice Address - Country:US
Practice Address - Phone:425-391-5270
Practice Address - Fax:425-391-8091
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-10-28
Last Update Date:2022-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332900000XSuppliersNon-Pharmacy Dispensing Site