Provider Demographics
NPI:1497159016
Name:PURPLE MOUNTAIN INTEGRATED HEALING ARTS
Entity Type:Organization
Organization Name:PURPLE MOUNTAIN INTEGRATED HEALING ARTS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER, CONSULTING PHARMACIST
Authorized Official - Prefix:DR
Authorized Official - First Name:STEPHANIE
Authorized Official - Middle Name:
Authorized Official - Last Name:BALL
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMD
Authorized Official - Phone:303-674-9240
Mailing Address - Street 1:27905 MEADOW DR UNIT 8
Mailing Address - Street 2:
Mailing Address - City:EVERGREEN
Mailing Address - State:CO
Mailing Address - Zip Code:80439-2113
Mailing Address - Country:US
Mailing Address - Phone:303-674-1365
Mailing Address - Fax:
Practice Address - Street 1:27905 MEADOW DR UNIT 8
Practice Address - Street 2:
Practice Address - City:EVERGREEN
Practice Address - State:CO
Practice Address - Zip Code:80439-2113
Practice Address - Country:US
Practice Address - Phone:303-674-1365
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-10-09
Last Update Date:2014-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center