Provider Demographics
NPI:1013214881
Name:VIVACITY HEALTH, LLC
Entity Type:Organization
Organization Name:VIVACITY HEALTH, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:NATUROPATH
Authorized Official - Prefix:DR
Authorized Official - First Name:SARA
Authorized Official - Middle Name:
Authorized Official - Last Name:LOVE
Authorized Official - Suffix:
Authorized Official - Credentials:ND
Authorized Official - Phone:503-708-6781
Mailing Address - Street 1:6327 SW CAPITOL HWY STE C
Mailing Address - Street 2:PMB#136
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97239-2190
Mailing Address - Country:US
Mailing Address - Phone:503-708-6781
Mailing Address - Fax:503-821-6357
Practice Address - Street 1:7689 SW CAPITOL HWY
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97219-2475
Practice Address - Country:US
Practice Address - Phone:503-708-6781
Practice Address - Fax:503-821-6357
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-02-14
Last Update Date:2012-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR1762261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center