Provider Demographics
NPI:1700446085
Name:HEALTHY LIVING COMMUNITY
Entity Type:Organization
Organization Name:HEALTHY LIVING COMMUNITY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR / MD
Authorized Official - Prefix:
Authorized Official - First Name:MATTHEW
Authorized Official - Middle Name:S
Authorized Official - Last Name:WHITACRE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:360-640-8833
Mailing Address - Street 1:3605 SE 26TH AVE
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97202-2953
Mailing Address - Country:US
Mailing Address - Phone:971-231-4536
Mailing Address - Fax:503-376-3790
Practice Address - Street 1:3605 SE 26TH AVE
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97202-2953
Practice Address - Country:US
Practice Address - Phone:971-231-4536
Practice Address - Fax:503-376-3790
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-06-18
Last Update Date:2023-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
No207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty