Provider Demographics
NPI:1235819970
Name:LIVE. GROW. SHARE. LLC
Entity Type:Organization
Organization Name:LIVE. GROW. SHARE. LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:ASHLEY
Authorized Official - Middle Name:NICHOLE
Authorized Official - Last Name:TEETERS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:541-525-3139
Mailing Address - Street 1:1966 GARDEN AVE
Mailing Address - Street 2:
Mailing Address - City:EUGENE
Mailing Address - State:OR
Mailing Address - Zip Code:97403-1933
Mailing Address - Country:US
Mailing Address - Phone:541-505-9190
Mailing Address - Fax:541-505-9264
Practice Address - Street 1:1966 GARDEN AVE
Practice Address - Street 2:
Practice Address - City:EUGENE
Practice Address - State:OR
Practice Address - Zip Code:97403-1933
Practice Address - Country:US
Practice Address - Phone:541-505-9190
Practice Address - Fax:541-505-9264
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:LIVE. GROW. SHARE. LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2023-07-18
Last Update Date:2024-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0405XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Substance Use Disorder