Provider Demographics
NPI:1346679750
Name:HEALTHY DIRECTIONS
Entity Type:Organization
Organization Name:HEALTHY DIRECTIONS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:K.
Authorized Official - Middle Name:SCOTT
Authorized Official - Last Name:TIFFANY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:480-250-4603
Mailing Address - Street 1:3595 HULSEY AVE SE
Mailing Address - Street 2:
Mailing Address - City:SALEM
Mailing Address - State:OR
Mailing Address - Zip Code:97302-2664
Mailing Address - Country:US
Mailing Address - Phone:480-250-4603
Mailing Address - Fax:
Practice Address - Street 1:9628 W STATE ST
Practice Address - Street 2:
Practice Address - City:STAR
Practice Address - State:ID
Practice Address - Zip Code:83669-5858
Practice Address - Country:US
Practice Address - Phone:480-250-4603
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-11-06
Last Update Date:2013-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
No251B00000XAgenciesCase Management