Provider Demographics
NPI:1568805414
Name:HEALTHY LIFE CENTRE FOR WELLNESS
Entity Type:Organization
Organization Name:HEALTHY LIFE CENTRE FOR WELLNESS
Other - Org Name:ENCOMPASS NATURAL HEALTH CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:KRISTIE
Authorized Official - Middle Name:F
Authorized Official - Last Name:RITCHEY
Authorized Official - Suffix:
Authorized Official - Credentials:ND
Authorized Official - Phone:503-635-4656
Mailing Address - Street 1:30740 SW BOONES FERRY RD
Mailing Address - Street 2:
Mailing Address - City:WILSONVILLE
Mailing Address - State:OR
Mailing Address - Zip Code:97070-9750
Mailing Address - Country:US
Mailing Address - Phone:503-236-2535
Mailing Address - Fax:503-635-4281
Practice Address - Street 1:4309 OAKRIDGE RD
Practice Address - Street 2:
Practice Address - City:LAKE OSWEGO
Practice Address - State:OR
Practice Address - Zip Code:97035-3418
Practice Address - Country:US
Practice Address - Phone:503-635-4656
Practice Address - Fax:503-635-4281
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-04-10
Last Update Date:2013-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care