ELEVEN ELEVEN, LLC (NPI# 1548667918) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1548667918 |
| Entity Type | Organization |
| Organization Name | ELEVEN ELEVEN, LLC |
| Practice Address |
6714 Sw 62nd Place Portland OR 97219 |
| Practice Telephone | 5039569773 |
| Mailing Telephone | 5039569773 |
| Enumeration Date | 2014-12-01 |
| Last Update Date | 2014-12-01 |
| Authorized Official Name | MR. ERIK BERNTSEN (OWNER) |
| Authorized Official Telephone | 5039569773 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 246ZA2600X |
Specialist/Technologist, Other Specialization: Art, Medical |
BAP-TA-10133461 | OR | Technologists, Technicians & Other Technical Service Providers |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| OR | CERTIFIED PERMANENT COSMETICS PROFESSIONAL | 155097 | 01 |
| Entity Type | Entity Name | Entity Address |
|---|---|---|
| Iowa Business Entities | ELEVEN ELEVEN, LLC | 312 Walnut Ave, Woodward, IA 50276 |
| Colorado Business Entities | Eleven Eleven, LLC | 459 Elk Ridge Road, Telluride, CO 81435 |
| Massachusetts Corporations | ELEVEN ELEVEN, LLC | 2302 Avalon Drive, Northborough, MA 01532 |
| Street Address |
6714 SW 62ND PLACE |
| City | PORTLAND |
| State | OR |
| Zip Code | 97219 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1356958672 | Lighthouse Psychological Services, LLC | Psychologist | 630 Sw Nevada St, Ste. E, Poralnd, OR 97219 | 2020-09-30 |
| 1083130991 | Tawayne Nolen Malone Jr. | Psychologist | 0615 Sw Palatine Hill Road, Tawayne Malone - Msc 2159, Portland, OR 97219 | 2017-08-22 |
| 1023414257 | Paul Shayne Hansen | Adult Companion | 9155 Sw 55th Avenue, Portland, OR 97219 | 2014-11-17 |
| 1154721850 | Mikhail Govshievich | Denturist | 9045 Sw Barbur Blvd. Suit 117, Portland, OR 97219 | 2014-08-29 |
| 1255749404 | Kristin Rae Paruszkiewicz | Physical Therapist | 7943 Sw Barbur Blvd #1, Portland, OR 97219 | 2014-07-31 |
| 1639436488 | Michelle Lorraine Emery | Counselor | 7912 Sw 35th, Portland, OR 97219 | 2012-04-18 |
| 1588930192 | Steve Ryan | Speech-Language Pathologist | 3315 Sw Falcon St, Portland, OR 97219 | 2012-03-28 |
| 1104145952 | Multnomah Family Care Center | Clinic/Center | 6787 Sw Capitol Hwy, Portland, OR 97219 | 2010-05-19 |
| 1740518331 | Trilbie L Patteson | Physical Therapy Assistant | 5701 Sw Multnomah Boulevard, West Hills Health and Rehab, Portland, OR 97219 | 2009-11-20 |
| 1538307384 | Travis J. Elliott Nd LLC | Naturopath | 1340 Sw Bertha Blvd, Suite 200, Portland, OR 97219 | 2009-02-02 |
| Find all providers in zip 97219 | ||||
| Taxonomy Code | 246ZA2600X |
| Grouping | Technologists, Technicians & Other Technical Service Providers |
| Classification | Specialist/Technologist, Other |
| Specialization | Art, Medical |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1326445651 | Erik Berntsen | Specialist/Technologist, Other | 1820 Sw Vermont St, Suite K, Portland, OR 97219-1945 | 2014-12-02 |
| 1164791992 | Mary Jane Haake | Specialist/Technologist, Other | 1017 Sw Morrison St, 205, Portland, OR 97205-2635 | 2011-12-22 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1609409523 | Miss Alter Ego Salon, LLC | Specialist/Technologist, Other | 21185 Nw West Union Rd, Hillsboro, OR 97124-8543 | 2020-02-19 |
| 1447741020 | Tanya Ilona Purt-nichols | Specialist/Technologist, Other | 10600 Se Mcloughlin Blvd Ste 203, Milwaukie, OR 97222-7428 | 2018-05-20 |
| 1851843023 | Joshua Travis South I | Specialist/Technologist, Other | 160 E 18th Ave, Eugene, OR 97401-4160 | 2016-11-03 |
| 1912343989 | Culp Enterprises, Inc. | Specialist/Technologist, Other | 81 Centennial Loop Ste 3, Eugene, OR 97401-2471 | 2013-05-17 |
| 1417211814 | Judith May Culp | Specialist/Technologist, Other | 81 Centennial Loop, Suite 3, Eugene, OR 97401-2471 | 2012-06-29 |
| 1285770958 | Kathleen Sue Sherwood | Specialist/Technologist, Other | 680 E 18th Ave, Eugene, OR 97401-4360 | 2007-01-30 |
| 1295353969 | Eain Varga | Specialist/Technologist, Other | 81 Centennial Loop Ste 3, Eugene, OR 97401-2471 | 2020-07-09 |
| 1942859160 | Esthetics Nw Services LLC | Specialist/Technologist, Other | 81 Centennial Loop Ste 3, Eugene, OR 97401-2471 | 2019-09-10 |
| 1821640673 | Michelle Varga | Specialist/Technologist, Other | 81 Centennial Loop Ste 3, Eugene, OR 97401-2471 | 2019-07-11 |
| 1447681648 | Anew You Studio LLC | Specialist/Technologist, Other | 100 King St S, Salem, OR 97302-4520 | 2013-12-12 |
| Find all providers with the same taxonomy | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.