Provider Demographics
NPI:1255167326
Name:ALIVE HEALTH AND WELLNESS, LLC
Entity type:Organization
Organization Name:ALIVE HEALTH AND WELLNESS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:STEPHANIE
Authorized Official - Middle Name:RUTH
Authorized Official - Last Name:NANI
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:971-294-9104
Mailing Address - Street 1:15160 NW LAIDLAW RD STE 222
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97229-7708
Mailing Address - Country:US
Mailing Address - Phone:971-470-0009
Mailing Address - Fax:971-470-0047
Practice Address - Street 1:15160 NW LAIDLAW RD STE 222
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97229-7708
Practice Address - Country:US
Practice Address - Phone:971-470-0009
Practice Address - Fax:971-470-0047
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-09-13
Last Update Date:2025-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QC1500XAmbulatory Health Care FacilitiesClinic/CenterCommunity Health
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
No261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service