Provider Demographics
NPI:1083040869
Name:A BALANCED LIFE HEALTH CARE
Entity Type:Organization
Organization Name:A BALANCED LIFE HEALTH CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MISS
Authorized Official - First Name:DEBBIE
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:VANETT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:503-236-4580
Mailing Address - Street 1:2005 SE HAWTHORNE BLVD.
Mailing Address - Street 2:20TH AND SE HAWTHORNE
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97214
Mailing Address - Country:US
Mailing Address - Phone:503-236-4580
Mailing Address - Fax:503-231-8400
Practice Address - Street 1:2005 SE HAWTHORNE BLVD
Practice Address - Street 2:20TH AND SE HAWTHORNE
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97214-3819
Practice Address - Country:US
Practice Address - Phone:503-236-4580
Practice Address - Fax:503-231-8400
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-09-24
Last Update Date:2013-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR020704040302R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes302R00000XManaged Care OrganizationsHealth Maintenance Organization