NPIMap

Organization Active NPI

Peach Willow LLC

Doing business as Peach Willow Spa

  • Other Technician
  • Vancouver, WA
National Provider Identifier
1932608049
Registry record updated Jun 11, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Other TechnicianTaxonomy code 247200000X
License
89329 Issued in WA
Legal business name
PEACH WILLOW LLC
Doing business as
Peach Willow Spa
Practice address
9015 E Mill Plain Blvd
Vancouver, WA 98664-2536
Phone
(360) 773-5110
NPI assigned
Feb 3, 2018
Last updated
Jun 11, 2019By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 11, 2019

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

Authorized official

Name
Mr. John Goode
Title
General Manager
Phone
(360) 773-5110

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Other Technician 247200000X 89329 WA Primary

Addresses

Primary practice location

9015 E Mill Plain Blvd
Vancouver, WA 98664-2536

Mailing address

9015 E Mill Plain Blvd
Vancouver, WA 98664-2536
Phone (360) 773-5110

Other names 1

  • Peach Willow Spa Doing business as

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1517616000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1560211200000",
    "number": "1932608049",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "9015 E MILL PLAIN BLVD",
            "city": "VANCOUVER",
            "state": "WA",
            "postal_code": "986642536",
            "telephone_number": "360-773-5110"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9015 E MILL PLAIN BLVD",
            "city": "VANCOUVER",
            "state": "WA",
            "postal_code": "986642536",
            "telephone_number": "360-773-5110"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PEACH WILLOW LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2018-02-03",
        "last_updated": "2019-06-11",
        "status": "A",
        "authorized_official_last_name": "GOODE",
        "authorized_official_first_name": "JOHN",
        "authorized_official_title_or_position": "GENERAL MANAGER",
        "authorized_official_telephone_number": "360-773-5110",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "247200000X",
            "taxonomy_group": "",
            "desc": "Technician, Other",
            "state": "WA",
            "license": "89329",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Peach Willow Spa",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Vancouver, WA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 11, 2019; 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.