Provider Demographics
NPI:1528348042
Name:ORAL HEALTH FOR LIFE, LLC
Entity type:Organization
Organization Name:ORAL HEALTH FOR LIFE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTAL HYGIENIST
Authorized Official - Prefix:MS
Authorized Official - First Name:LORI
Authorized Official - Middle Name:KILLEN
Authorized Official - Last Name:AUS
Authorized Official - Suffix:
Authorized Official - Credentials:RDH, MA
Authorized Official - Phone:503-319-3412
Mailing Address - Street 1:2574 TROY CT
Mailing Address - Street 2:
Mailing Address - City:WEST LINN
Mailing Address - State:OR
Mailing Address - Zip Code:97068-7306
Mailing Address - Country:US
Mailing Address - Phone:503-319-3412
Mailing Address - Fax:
Practice Address - Street 1:2574 TROY CT
Practice Address - Street 2:
Practice Address - City:WEST LINN
Practice Address - State:OR
Practice Address - Zip Code:97068-7306
Practice Address - Country:US
Practice Address - Phone:503-319-3412
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-08-29
Last Update Date:2011-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORH1599310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility