The Golden Room LLC

Primary specialty

SpecialistTaxonomy code 174400000X

License

8161 Issued in OR

Legal business name

THE GOLDEN ROOM LLC

Practice address

636 SE 49TH Ave
Portland, OR 97215-1728

Phone

(971) 506-4560

NPI assigned

Dec 27, 2012

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Mauri McKitrick

Title

Owner/LMT

Phone

(971) 506-4560

Specialties & licenses 1

Addresses

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Jill Kathryn Bishop, L.M.T.

  • Massage Therapist
  • Portland, OR
  • NPI 1275888919
  NPD (past)
• Olivia M. Kellar, LAC, MACOM, LMT

  • Acupuncturist
  • Portland, OR
  • NPI 1598191009
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1356566400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1356566400000",
    "number": "1205172913",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4360 NE SIMPSON ST",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972181444",
            "telephone_number": "971-506-4560"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "636 SE 49TH AVE",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972151728",
            "telephone_number": "971-506-4560"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "THE GOLDEN ROOM LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-12-27",
        "last_updated": "2012-12-27",
        "status": "A",
        "authorized_official_last_name": "MCKITRICK",
        "authorized_official_first_name": "MAURI",
        "authorized_official_title_or_position": "OWNER/LMT",
        "authorized_official_telephone_number": "971-506-4560"
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Specialist",
            "state": "OR",
            "license": "8161",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Specialist in Portland, OR
• Providers in Portland, OR by specialty
• Specialist in Oregon

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 27, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.