Provider Demographics
NPI:1821575192
Name:HEALING HOUSE IN SCOTTSDALE, LLC
Entity Type:Organization
Organization Name:HEALING HOUSE IN SCOTTSDALE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER, ACUPUNCTURIST
Authorized Official - Prefix:MR
Authorized Official - First Name:MUKHTAR
Authorized Official - Middle Name:FREDERIC
Authorized Official - Last Name:RAMSEY
Authorized Official - Suffix:
Authorized Official - Credentials:LAC
Authorized Official - Phone:480-463-4685
Mailing Address - Street 1:4300 N MILLER RD STE 213
Mailing Address - Street 2:
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85251-3622
Mailing Address - Country:US
Mailing Address - Phone:602-568-0750
Mailing Address - Fax:
Practice Address - Street 1:4300 N MILLER RD STE 213
Practice Address - Street 2:
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85251-3622
Practice Address - Country:US
Practice Address - Phone:602-568-0750
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-07-19
Last Update Date:2020-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ0605171100000X
171100000X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty
No171100000XOther Service ProvidersAcupuncturistGroup - Single Specialty