Healthcare Provider Details

I. General information

NPI: 1871044917
Provider Name (Legal Business Name): OREGON CENTER FOR OPTIMAL HEALTH
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/24/2016
Last Update Date: 01/09/2023
Certification Date: 01/09/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

504B CASCADE AVE
HOOD RIVER OR
97031-2088
US

IV. Provider business mailing address

504B CASCADE AVE
HOOD RIVER OR
97031-2088
US

V. Phone/Fax

Practice location:
  • Phone: 541-490-5719
  • Fax:
Mailing address:
  • Phone: 541-490-5719
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number3047
License Number StateOR
# 2
Primary TaxonomyN
Taxonomy Code261QH0100X
TaxonomyHealth Service Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. ERIC JORGENSON
Title or Position: OWNER
Credential: ND
Phone: 541-490-5719