Provider Demographics
NPI:1043703838
Name:INTERRA HEALTH INC.
Entity Type:Organization
Organization Name:INTERRA HEALTH INC.
Other - Org Name:LIFE WELLNESS CENTER - APPLETON
Other - Org Type:Doing Business As
Authorized Official - Title/Position:IMPLEMENTATION & TRAINING COORDINAT
Authorized Official - Prefix:
Authorized Official - First Name:MICHELLE
Authorized Official - Middle Name:D
Authorized Official - Last Name:RUTH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:414-375-1623
Mailing Address - Street 1:8919 W HEATHER AVE
Mailing Address - Street 2:
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53224-2417
Mailing Address - Country:US
Mailing Address - Phone:414-375-1623
Mailing Address - Fax:
Practice Address - Street 1:5 INNOVATION CT STE B
Practice Address - Street 2:
Practice Address - City:APPLETON
Practice Address - State:WI
Practice Address - Zip Code:54914-1739
Practice Address - Country:US
Practice Address - Phone:920-727-7223
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-06-07
Last Update Date:2018-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care