Healthcare Provider Details

I. General information

NPI: 1104918275
Provider Name (Legal Business Name): PEARL HEALTH CENTER,PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/28/2006
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

721 NW 9TH AVE STE 100A
PORTLAND OR
97209-3477
US

IV. Provider business mailing address

721 NW 9TH AVE STE 100A
PORTLAND OR
97209-3477
US

V. Phone/Fax

Practice location:
  • Phone: 503-525-0090
  • Fax: 971-244-0219
Mailing address:
  • Phone: 503-525-0090
  • Fax: 971-244-0219

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number StateOR
# 2
Primary TaxonomyY
Taxonomy Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License Number363LFOOOOX
License Number StateOR

VIII. Authorized Official

Name: MRS. SHARI S FRESHMAN HOUSE
Title or Position: PRESIDENT,NURSE PRACTITIONER
Credential: FNP
Phone: 503-525-0090