Most Relevant Information
Provider Data
| NPI Number: | 1003239757 |
| Provider Name: | HEAVEN WOODS |
| Entity Type: | Individual |
| Taxonomy Code: | 172V00000X |
| Specialty: | Community Health Worker |
| License Number: |
Most Important Dates
| Enumeration Date: | 01/31/2014 |
| Last Updated: | 01/31/2014 |
Provider Practice Location
847 NE 19TH AVE
PORTLAND
OR
972322684
Practice Location Phone/Fax
| Phone: | 5032380769 |
| Fax: |
Provider Mailing Location
PO BOX 8459
PORTLAND
OR
972078459
Provider Mailing Phone/Fax
| Phone: | 5032380769 |
| Fax: |