Provider Demographics
NPI:1003047721
Name:CYCLES OF LIFE HEALTH CARE PLLC
Entity Type:Organization
Organization Name:CYCLES OF LIFE HEALTH CARE PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROVIDER/OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:DONNA
Authorized Official - Middle Name:J
Authorized Official - Last Name:FOORD
Authorized Official - Suffix:
Authorized Official - Credentials:PA-C
Authorized Official - Phone:208-263-1345
Mailing Address - Street 1:1301 NORTH DIVISION STREET
Mailing Address - Street 2:
Mailing Address - City:SANDPOINT
Mailing Address - State:ID
Mailing Address - Zip Code:83864
Mailing Address - Country:US
Mailing Address - Phone:208-363-1345
Mailing Address - Fax:208-255-5531
Practice Address - Street 1:1301 N DIVISION AVE
Practice Address - Street 2:
Practice Address - City:SANDPOINT
Practice Address - State:ID
Practice Address - Zip Code:83864-8268
Practice Address - Country:US
Practice Address - Phone:208-363-1345
Practice Address - Fax:208-255-5531
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-07-29
Last Update Date:2012-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDRPA-156261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
ID00261900Medicaid
ID1665645Medicare PIN
ID00261900Medicaid