Provider Demographics
NPI:1871838391
Name:HEALTHY U
Entity Type:Organization
Organization Name:HEALTHY U
Other - Org Name:ILLINOIS VALLEY COUNSELING AND SUPPORT
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:NICOLE
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:RENSENBRINK
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:541-592-4888
Mailing Address - Street 1:PO BOX 1491
Mailing Address - Street 2:
Mailing Address - City:CAVE JUNCTION
Mailing Address - State:OR
Mailing Address - Zip Code:97523-1491
Mailing Address - Country:US
Mailing Address - Phone:541-592-4888
Mailing Address - Fax:
Practice Address - Street 1:535 E RIVER ST
Practice Address - Street 2:
Practice Address - City:CAVE JUNCTION
Practice Address - State:OR
Practice Address - Zip Code:97523-9336
Practice Address - Country:US
Practice Address - Phone:541-592-4888
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-12-10
Last Update Date:2014-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
ORR169576Medicare Oscar/Certification