Provider Demographics
NPI:1386132066
Name:ONE SPACE HEALTH CARE
Entity type:Organization
Organization Name:ONE SPACE HEALTH CARE
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CBCS
Authorized Official - Prefix:
Authorized Official - First Name:MELISSA
Authorized Official - Middle Name:
Authorized Official - Last Name:AHNEMANN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:808-349-2274
Mailing Address - Street 1:4263 HARVEY WAY
Mailing Address - Street 2:
Mailing Address - City:LAKE OSWEGO
Mailing Address - State:OR
Mailing Address - Zip Code:97035-3412
Mailing Address - Country:US
Mailing Address - Phone:808-349-2274
Mailing Address - Fax:
Practice Address - Street 1:15962 BOONES FERRY RD STE 204
Practice Address - Street 2:
Practice Address - City:LAKE OSWEGO
Practice Address - State:OR
Practice Address - Zip Code:97035-4360
Practice Address - Country:US
Practice Address - Phone:503-675-2439
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:JESSICA M EVANS ND
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2018-04-27
Last Update Date:2018-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes175F00000XOther Service ProvidersNaturopathGroup - Single Specialty