Provider Demographics
NPI:1013550441
Name:INTENTIONAL LIVING PROGRAMS, LLC
Entity Type:Organization
Organization Name:INTENTIONAL LIVING PROGRAMS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SANDRA
Authorized Official - Middle Name:
Authorized Official - Last Name:BARTHOLOMEW
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:541-298-8227
Mailing Address - Street 1:405 W 4TH ST
Mailing Address - Street 2:
Mailing Address - City:THE DALLES
Mailing Address - State:OR
Mailing Address - Zip Code:97058-1305
Mailing Address - Country:US
Mailing Address - Phone:541-298-8227
Mailing Address - Fax:541-769-0153
Practice Address - Street 1:405 W 4TH ST
Practice Address - Street 2:
Practice Address - City:THE DALLES
Practice Address - State:OR
Practice Address - Zip Code:97058-1305
Practice Address - Country:US
Practice Address - Phone:541-298-8227
Practice Address - Fax:541-769-0153
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-10-17
Last Update Date:2019-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty