Provider Demographics
NPI:1669605424
Name:AZALEA FAMILY HEALTH CARE LLC
Entity type:Organization
Organization Name:AZALEA FAMILY HEALTH CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:FRANCES
Authorized Official - Middle Name:E
Authorized Official - Last Name:GUTHRIDGE
Authorized Official - Suffix:
Authorized Official - Credentials:FNP
Authorized Official - Phone:541-469-0402
Mailing Address - Street 1:PO BOX 7706
Mailing Address - Street 2:
Mailing Address - City:BROOKINGS
Mailing Address - State:OR
Mailing Address - Zip Code:97415-0366
Mailing Address - Country:US
Mailing Address - Phone:541-469-1919
Mailing Address - Fax:541-469-4949
Practice Address - Street 1:937 CHETCO AVE.
Practice Address - Street 2:
Practice Address - City:BROOKINGS
Practice Address - State:OR
Practice Address - Zip Code:97415
Practice Address - Country:US
Practice Address - Phone:541-469-1919
Practice Address - Fax:541-469-4949
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-08-27
Last Update Date:2009-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care