Provider Demographics
NPI:1750743290
Name:RURAL HEALTH COLLECTIVE
Entity type:Organization
Organization Name:RURAL HEALTH COLLECTIVE
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:GABRIELLE
Authorized Official - Middle Name:
Authorized Official - Last Name:CARTER
Authorized Official - Suffix:
Authorized Official - Credentials:ND
Authorized Official - Phone:503-395-2500
Mailing Address - Street 1:7738 SW 31ST AVE
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97219-2420
Mailing Address - Country:US
Mailing Address - Phone:503-395-2500
Mailing Address - Fax:844-811-6370
Practice Address - Street 1:1340 SW BERTHA BLVD
Practice Address - Street 2:STE 200
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97219-2172
Practice Address - Country:US
Practice Address - Phone:503-395-2500
Practice Address - Fax:844-811-6370
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:RURAL HEALTH COLLECTIVE
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2016-03-23
Last Update Date:2022-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
175F00000X, 175L00000X
OR3015175F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes175F00000XOther Service ProvidersNaturopathGroup - Single Specialty
No175L00000XOther Service ProvidersHomeopathGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR500698041Medicaid