Provider Demographics
NPI:1083320725
Name:HEALTHY LIVING FOUNDATION INC
Entity Type:Organization
Organization Name:HEALTHY LIVING FOUNDATION INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:RASHAD
Authorized Official - Middle Name:QUINT'E
Authorized Official - Last Name:RICHARDSON
Authorized Official - Suffix:SR
Authorized Official - Credentials:DOCTOR OF SPORT MED
Authorized Official - Phone:336-740-1668
Mailing Address - Street 1:10418 N MAIN ST STE K
Mailing Address - Street 2:
Mailing Address - City:ARCHDALE
Mailing Address - State:NC
Mailing Address - Zip Code:27263-3282
Mailing Address - Country:US
Mailing Address - Phone:336-740-1668
Mailing Address - Fax:
Practice Address - Street 1:10418 N MAIN ST STE K
Practice Address - Street 2:
Practice Address - City:ARCHDALE
Practice Address - State:NC
Practice Address - Zip Code:27263-3282
Practice Address - Country:US
Practice Address - Phone:336-740-1668
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-01-26
Last Update Date:2023-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207QS0010XAllopathic & Osteopathic PhysiciansFamily MedicineSports MedicineGroup - Multi-Specialty
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
No103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Multi-Specialty
No103TE1100XBehavioral Health & Social Service ProvidersPsychologistExercise & SportsGroup - Multi-Specialty
No171400000XOther Service ProvidersHealth & Wellness CoachGroup - Multi-Specialty
No174H00000XOther Service ProvidersHealth EducatorGroup - Multi-Specialty
No302R00000XManaged Care OrganizationsHealth Maintenance OrganizationGroup - Multi-Specialty