Provider Demographics
NPI:1649515065
Name:ANCIENT RIVERS HEALING ARTS, INC.
Entity type:Organization
Organization Name:ANCIENT RIVERS HEALING ARTS, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MS
Authorized Official - First Name:SARIANTRA
Authorized Official - Middle Name:REE
Authorized Official - Last Name:KALI
Authorized Official - Suffix:
Authorized Official - Credentials:LAC
Authorized Official - Phone:541-221-3282
Mailing Address - Street 1:1695 JEFFERSON ST
Mailing Address - Street 2:
Mailing Address - City:EUGENE
Mailing Address - State:OR
Mailing Address - Zip Code:97402-4063
Mailing Address - Country:US
Mailing Address - Phone:541-221-3282
Mailing Address - Fax:
Practice Address - Street 1:1695 JEFFERSON ST
Practice Address - Street 2:
Practice Address - City:EUGENE
Practice Address - State:OR
Practice Address - Zip Code:97402-4063
Practice Address - Country:US
Practice Address - Phone:541-221-3282
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-12-11
Last Update Date:2014-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORACU150532261QM2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty