Healthcare Provider Details

I. General information

NPI: 1831029495
Provider Name (Legal Business Name): PEERS FOR LOVE, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/22/2026
Last Update Date: 05/22/2026
Certification Date: 05/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

700 MARION ST NE
SALEM OR
97301-3829
US

IV. Provider business mailing address

1173 S 10TH ST
INDEPENDENCE OR
97351-1563
US

V. Phone/Fax

Practice location:
  • Phone: 570-947-4492
  • Fax:
Mailing address:
  • Phone: 570-947-4492
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code175T00000X
TaxonomyPeer Specialist
License Number
License Number State

VIII. Authorized Official

Name: JOHN K LAVELLE
Title or Position: CO-EXECUTIVE DIRECTOR
Credential: PSS, PWS, CRM
Phone: 570-947-4492