Provider Demographics
NPI:1841883741
Name:TRUE NORTH WELLNESS CENTER
Entity type:Organization
Organization Name:TRUE NORTH WELLNESS CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/ADMINISTRATOR
Authorized Official - Prefix:DR
Authorized Official - First Name:F
Authorized Official - Middle Name:BLAKE
Authorized Official - Last Name:AMBRIDGE
Authorized Official - Suffix:
Authorized Official - Credentials:ND
Authorized Official - Phone:208-946-5888
Mailing Address - Street 1:1327 W SUPERIOR ST STE 104
Mailing Address - Street 2:
Mailing Address - City:SANDPOINT
Mailing Address - State:ID
Mailing Address - Zip Code:83864-2742
Mailing Address - Country:US
Mailing Address - Phone:208-946-5888
Mailing Address - Fax:
Practice Address - Street 1:1327 W SUPERIOR ST STE 104
Practice Address - Street 2:
Practice Address - City:SANDPOINT
Practice Address - State:ID
Practice Address - Zip Code:83864-2742
Practice Address - Country:US
Practice Address - Phone:208-946-5888
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-02-11
Last Update Date:2021-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes175F00000XOther Service ProvidersNaturopathGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IDMEDICAREOtherMEDICARE PTAN