Provider Demographics
NPI:1346899267
Name:HEALTHYU NUTRITION
Entity Type:Organization
Organization Name:HEALTHYU NUTRITION
Other - Org Name:CREATIVE JUICES NUTRITION THERAPY & EDUCATION
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:CARY
Authorized Official - Middle Name:
Authorized Official - Last Name:FARDAL
Authorized Official - Suffix:
Authorized Official - Credentials:RDN, LD
Authorized Official - Phone:503-855-6171
Mailing Address - Street 1:7140 SE 112TH AVE
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97266-5030
Mailing Address - Country:US
Mailing Address - Phone:503-855-6171
Mailing Address - Fax:
Practice Address - Street 1:14210 SE SUNNYSIDE RD
Practice Address - Street 2:
Practice Address - City:CLACKAMAS
Practice Address - State:OR
Practice Address - Zip Code:97015-5240
Practice Address - Country:US
Practice Address - Phone:503-855-6171
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-09-04
Last Update Date:2023-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service
No251V00000XAgenciesVoluntary or Charitable
No261QC1500XAmbulatory Health Care FacilitiesClinic/CenterCommunity Health