Provider Demographics
NPI:1013114172
Name:HEALING SPIRIT INTEGRATIVE HEALTH CENTER INC
Entity Type:Organization
Organization Name:HEALING SPIRIT INTEGRATIVE HEALTH CENTER INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT AND NURSE PRACTITIONER
Authorized Official - Prefix:
Authorized Official - First Name:CARMA
Authorized Official - Middle Name:JB
Authorized Official - Last Name:DOUGLAS
Authorized Official - Suffix:
Authorized Official - Credentials:NP
Authorized Official - Phone:541-683-1125
Mailing Address - Street 1:1355 OAK ST STE 100
Mailing Address - Street 2:
Mailing Address - City:EUGENE
Mailing Address - State:OR
Mailing Address - Zip Code:97401-3566
Mailing Address - Country:US
Mailing Address - Phone:541-683-1125
Mailing Address - Fax:541-683-2049
Practice Address - Street 1:1355 OAK ST STE 100
Practice Address - Street 2:
Practice Address - City:EUGENE
Practice Address - State:OR
Practice Address - Zip Code:97401-3566
Practice Address - Country:US
Practice Address - Phone:541-683-1125
Practice Address - Fax:541-683-2049
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-29
Last Update Date:2019-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR200841796RN261QM1300X
OR201508020RN261QM1300X, 261QM1300X
OR81001432RN(N3)261QP2300X, 261QP2300X
OR080045015NS261QP2300X, 261QP2300X
261QP2300X
OR096000551RN261QM1300X
089003081RN261QM1300X
OR18234225700000X
OR21435225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary CareGroup - Multi-Specialty
No261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-SpecialtyGroup - Multi-Specialty
No225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR500667910Medicaid
OR500667910Medicaid