Provider Demographics
NPI:1922751346
Name:PROHEALTH PROVIDERS LLC
Entity Type:Organization
Organization Name:PROHEALTH PROVIDERS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:GOVERNOR
Authorized Official - Prefix:
Authorized Official - First Name:JANE
Authorized Official - Middle Name:
Authorized Official - Last Name:BELL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:253-533-3553
Mailing Address - Street 1:10908 56TH AVENUE CT E APT P302
Mailing Address - Street 2:
Mailing Address - City:PUYALLUP
Mailing Address - State:WA
Mailing Address - Zip Code:98373-5763
Mailing Address - Country:US
Mailing Address - Phone:125-353-3355
Mailing Address - Fax:
Practice Address - Street 1:10908 56TH AVENUE CT E APT P302
Practice Address - Street 2:
Practice Address - City:PUYALLUP
Practice Address - State:WA
Practice Address - Zip Code:98373-5763
Practice Address - Country:US
Practice Address - Phone:125-353-3355
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-01-27
Last Update Date:2022-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center