Provider Demographics
NPI:1104918275
Name:PEARL HEALTH CENTER,PC
Entity type:Organization
Organization Name:PEARL HEALTH CENTER,PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT,NURSE PRACTITIONER
Authorized Official - Prefix:MRS
Authorized Official - First Name:SHARI
Authorized Official - Middle Name:S
Authorized Official - Last Name:FRESHMAN HOUSE
Authorized Official - Suffix:
Authorized Official - Credentials:FNP
Authorized Official - Phone:503-525-0090
Mailing Address - Street 1:721 NW 9TH AVE STE 100A
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97209-3477
Mailing Address - Country:US
Mailing Address - Phone:503-525-0090
Mailing Address - Fax:971-244-0219
Practice Address - Street 1:721 NW 9TH AVE STE 100A
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97209-3477
Practice Address - Country:US
Practice Address - Phone:503-525-0090
Practice Address - Fax:971-244-0219
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-28
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR261Q00000X
OR363LFOOOOX261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Not Answered261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR027741Medicaid
ORR121751Medicare ID - Type Unspecified