Provider Demographics
NPI:1427232271
Name:NORTHWEST HEALTH & LIFESTYLE CENTRE
Entity Type:Organization
Organization Name:NORTHWEST HEALTH & LIFESTYLE CENTRE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF HEALTH & WELLNESS
Authorized Official - Prefix:DR
Authorized Official - First Name:JASON
Authorized Official - Middle Name:M
Authorized Official - Last Name:COLLINS
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:479-254-9355
Mailing Address - Street 1:700 S WALTON BLVD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:BENTONVILLE
Mailing Address - State:AR
Mailing Address - Zip Code:72712-5751
Mailing Address - Country:US
Mailing Address - Phone:479-254-9355
Mailing Address - Fax:479-254-9360
Practice Address - Street 1:700 S WALTON BLVD
Practice Address - Street 2:SUITE 100
Practice Address - City:BENTONVILLE
Practice Address - State:AR
Practice Address - Zip Code:72712-5751
Practice Address - Country:US
Practice Address - Phone:479-254-9355
Practice Address - Fax:479-254-9360
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-27
Last Update Date:2008-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR1532261QM1300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty