Provider Demographics
NPI:1356484380
Name:WARM SPRINGS HEALTH AND WELLNESS CENTER
Entity Type:Organization
Organization Name:WARM SPRINGS HEALTH AND WELLNESS CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PODIATRY TECH NURSING ASSISTANT
Authorized Official - Prefix:MRS
Authorized Official - First Name:ROSE
Authorized Official - Middle Name:LEE
Authorized Official - Last Name:RUDDER
Authorized Official - Suffix:
Authorized Official - Credentials:PMAC
Authorized Official - Phone:541-553-1196
Mailing Address - Street 1:PO BOX 1209
Mailing Address - Street 2:1270 KOT NUM ROAD
Mailing Address - City:WARM SPRINGS
Mailing Address - State:OR
Mailing Address - Zip Code:97761-1209
Mailing Address - Country:US
Mailing Address - Phone:541-553-1196
Mailing Address - Fax:541-553-2613
Practice Address - Street 1:1270 KOT NUM ROAD
Practice Address - Street 2:
Practice Address - City:WARM SPRINGS
Practice Address - State:OR
Practice Address - Zip Code:97761-1209
Practice Address - Country:US
Practice Address - Phone:541-553-1196
Practice Address - Fax:541-553-2613
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-15
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP0904XAmbulatory Health Care FacilitiesClinic/CenterPublic Health, Federal
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR3268OtherAMERICAN SOCIETY OF PODIA