Healthcare Provider Details

I. General information

NPI: 1457097479
Provider Name (Legal Business Name): YNTIMATE LI OU LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/11/2022
Last Update Date: 09/20/2024
Certification Date: 09/20/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5311 SE POWELL BLVD STE 102
PORTLAND OR
97206-2951
US

IV. Provider business mailing address

5311 SE POWELL BLVD STE 102
PORTLAND OR
97206-2951
US

V. Phone/Fax

Practice location:
  • Phone: 503-793-0977
  • Fax: 503-961-1946
Mailing address:
  • Phone: 503-793-0977
  • Fax: 503-961-1946

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code374J00000X
TaxonomyDoula
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code376K00000X
TaxonomyNurse's Aide
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code171400000X
TaxonomyHealth & Wellness Coach
License Number
License Number State

VIII. Authorized Official

Name: MS. JONA Y ALLEN
Title or Position: OWNER
Credential: CHWC; CD; NH; PF
Phone: 503-793-0977