Provider Demographics
NPI:1528113982
Name:AVADA OF OREGON, INC.
Entity type:Organization
Organization Name:AVADA OF OREGON, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:STEVE
Authorized Official - Middle Name:W
Authorized Official - Last Name:BARLOW
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:502-253-9802
Mailing Address - Street 1:12724 SE STARK STREET, BUILDING H
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97233
Mailing Address - Country:US
Mailing Address - Phone:503-253-3131
Mailing Address - Fax:503-253-2895
Practice Address - Street 1:12724 SE STARK STREET, BUILDING H
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97233
Practice Address - Country:US
Practice Address - Phone:503-253-3131
Practice Address - Fax:503-253-2895
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-24
Last Update Date:2013-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR237700000X
332S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes332S00000XSuppliersHearing Aid Equipment
No237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument SpecialistGroup - Single Specialty