Provider Demographics
NPI:1184091209
Name:STILLWATER SPA & WELLNESS CENTER
Entity type:Organization
Organization Name:STILLWATER SPA & WELLNESS CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:HOLLY
Authorized Official - Middle Name:
Authorized Official - Last Name:ARMSTRONG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:541-887-2507
Mailing Address - Street 1:1775 WASHBURN WAY STE A
Mailing Address - Street 2:
Mailing Address - City:KLAMATH FALLS
Mailing Address - State:OR
Mailing Address - Zip Code:97603-4304
Mailing Address - Country:US
Mailing Address - Phone:541-887-2507
Mailing Address - Fax:541-887-2508
Practice Address - Street 1:1775 WASHBURN WAY STE A
Practice Address - Street 2:
Practice Address - City:KLAMATH FALLS
Practice Address - State:OR
Practice Address - Zip Code:97603-4304
Practice Address - Country:US
Practice Address - Phone:541-887-2507
Practice Address - Fax:541-887-2508
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-08-24
Last Update Date:2015-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes305S00000XManaged Care OrganizationsPoint of Service