Provider Demographics
NPI:1598106692
Name:HEAL GROW THRIVE MEDICINE LLC
Entity Type:Organization
Organization Name:HEAL GROW THRIVE MEDICINE LLC
Other - Org Name:HEAL GROW THRIVE ACUPUNCTURE LLC
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:OWNER/SOLE MEMBER
Authorized Official - Prefix:MS
Authorized Official - First Name:MARGARET
Authorized Official - Middle Name:ILEANA
Authorized Official - Last Name:BOURLAND
Authorized Official - Suffix:
Authorized Official - Credentials:LAC
Authorized Official - Phone:541-639-8911
Mailing Address - Street 1:999 SW DISK DRIVE
Mailing Address - Street 2:SUITE 105
Mailing Address - City:BEND
Mailing Address - State:OR
Mailing Address - Zip Code:97702
Mailing Address - Country:US
Mailing Address - Phone:541-639-8911
Mailing Address - Fax:541-633-7962
Practice Address - Street 1:999 SW DISK DRIVE
Practice Address - Street 2:SUITE 105
Practice Address - City:BEND
Practice Address - State:OR
Practice Address - Zip Code:97702
Practice Address - Country:US
Practice Address - Phone:541-639-8911
Practice Address - Fax:541-633-7962
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-07-17
Last Update Date:2018-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORAC153140171100000X
OR4026175F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171100000XOther Service ProvidersAcupuncturistGroup - Single Specialty
No175F00000XOther Service ProvidersNaturopathGroup - Multi-Specialty