Provider Demographics
NPI:1588422398
Name:LOST IN THE ASTRAL
Entity type:Organization
Organization Name:LOST IN THE ASTRAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:SCOTT
Authorized Official - Middle Name:HERMAN
Authorized Official - Last Name:HINOJOSA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:503-664-0171
Mailing Address - Street 1:1713 NW 21ST ST # 104
Mailing Address - Street 2:
Mailing Address - City:LINCOLN CITY
Mailing Address - State:OR
Mailing Address - Zip Code:97367-3845
Mailing Address - Country:US
Mailing Address - Phone:503-664-0171
Mailing Address - Fax:
Practice Address - Street 1:1713 NW 21ST ST # 104
Practice Address - Street 2:
Practice Address - City:LINCOLN CITY
Practice Address - State:OR
Practice Address - Zip Code:97367-3845
Practice Address - Country:US
Practice Address - Phone:503-664-0171
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-03-07
Last Update Date:2024-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
No171M00000XOther Service ProvidersCase Manager/Care CoordinatorGroup - Multi-Specialty