Provider Demographics
NPI:1104568187
Name:LIVING ISLANDS NON-PROFIT
Entity type:Organization
Organization Name:LIVING ISLANDS NON-PROFIT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CIO/COO
Authorized Official - Prefix:MR
Authorized Official - First Name:JESPER
Authorized Official - Middle Name:RORBYE
Authorized Official - Last Name:ANGELO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:360-430-7660
Mailing Address - Street 1:PO BOX 366
Mailing Address - Street 2:
Mailing Address - City:LAKE OSWEGO
Mailing Address - State:OR
Mailing Address - Zip Code:97034-0366
Mailing Address - Country:US
Mailing Address - Phone:971-220-5484
Mailing Address - Fax:
Practice Address - Street 1:1585 PATTON RD
Practice Address - Street 2:
Practice Address - City:LAKE OSWEGO
Practice Address - State:OR
Practice Address - Zip Code:97034-6047
Practice Address - Country:US
Practice Address - Phone:971-220-5484
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-04-11
Last Update Date:2022-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251V00000XAgenciesVoluntary or Charitable