Provider Demographics
NPI:1194486779
Name:ADORE MEDIA GROUP LLC
Entity type:Organization
Organization Name:ADORE MEDIA GROUP LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:GINGER
Authorized Official - Middle Name:
Authorized Official - Last Name:JOHNSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:503-888-8849
Mailing Address - Street 1:2250 NW FLANDERS ST STE G2
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97210-3475
Mailing Address - Country:US
Mailing Address - Phone:503-888-8849
Mailing Address - Fax:
Practice Address - Street 1:2250 NW FLANDERS ST STE G2
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97210-3475
Practice Address - Country:US
Practice Address - Phone:503-888-8849
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:LOVE MEDICAL SPA
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2022-01-05
Last Update Date:2022-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care