Provider Demographics
NPI:1154695310
Name:SERVIAM WELLNESS INC
Entity type:Organization
Organization Name:SERVIAM WELLNESS INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESEDENT
Authorized Official - Prefix:
Authorized Official - First Name:RICK
Authorized Official - Middle Name:
Authorized Official - Last Name:SNOOK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:503-313-9245
Mailing Address - Street 1:18005 SW FITCH DR
Mailing Address - Street 2:
Mailing Address - City:SHERWOOD
Mailing Address - State:OR
Mailing Address - Zip Code:97140-8860
Mailing Address - Country:US
Mailing Address - Phone:503-925-9237
Mailing Address - Fax:
Practice Address - Street 1:18005 SW FITCH DR
Practice Address - Street 2:
Practice Address - City:SHERWOOD
Practice Address - State:OR
Practice Address - Zip Code:97140-8860
Practice Address - Country:US
Practice Address - Phone:503-925-9237
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-03-05
Last Update Date:2012-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR225700000X225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Single Specialty