Provider Demographics
NPI:1932963550
Name:ILA INTEGRATIVE HEALTH LLC
Entity Type:Organization
Organization Name:ILA INTEGRATIVE HEALTH LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPERATIONS MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:REBECCA
Authorized Official - Middle Name:
Authorized Official - Last Name:YAWMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:206-331-2483
Mailing Address - Street 1:820 N MONTANA AVE STE A
Mailing Address - Street 2:
Mailing Address - City:HELENA
Mailing Address - State:MT
Mailing Address - Zip Code:59601-4185
Mailing Address - Country:US
Mailing Address - Phone:406-422-0040
Mailing Address - Fax:
Practice Address - Street 1:820 N MONTANA AVE STE A
Practice Address - Street 2:
Practice Address - City:HELENA
Practice Address - State:MT
Practice Address - Zip Code:59601-4185
Practice Address - Country:US
Practice Address - Phone:406-422-0040
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-02-13
Last Update Date:2024-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty