Provider Demographics
NPI:1609317445
Name:SKY RIVER NATURAL HEALTH CENTER, INC
Entity Type:Organization
Organization Name:SKY RIVER NATURAL HEALTH CENTER, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:DOMINIKA
Authorized Official - Middle Name:
Authorized Official - Last Name:NEARY
Authorized Official - Suffix:
Authorized Official - Credentials:ND
Authorized Official - Phone:360-793-0206
Mailing Address - Street 1:PO BOX 1568
Mailing Address - Street 2:
Mailing Address - City:SULTAN
Mailing Address - State:WA
Mailing Address - Zip Code:98294-1568
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:33405 STATE ROUTE 2
Practice Address - Street 2:
Practice Address - City:SULTAN
Practice Address - State:WA
Practice Address - Zip Code:98294-8607
Practice Address - Country:US
Practice Address - Phone:360-793-0206
Practice Address - Fax:360-793-0214
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-03-13
Last Update Date:2017-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes175F00000XOther Service ProvidersNaturopathGroup - Single Specialty
No171100000XOther Service ProvidersAcupuncturistGroup - Single Specialty