Provider Demographics
NPI:1285255182
Name:HEARTH NATURAL MEDICINE A NONPROFIT COMMUNITY CLINIC
Entity type:Organization
Organization Name:HEARTH NATURAL MEDICINE A NONPROFIT COMMUNITY CLINIC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CLINIC DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:REBECCA
Authorized Official - Middle Name:EULALIA
Authorized Official - Last Name:SORNSON
Authorized Official - Suffix:
Authorized Official - Credentials:ND
Authorized Official - Phone:425-780-3131
Mailing Address - Street 1:PO BOX 1421
Mailing Address - Street 2:
Mailing Address - City:PORT HADLOCK
Mailing Address - State:WA
Mailing Address - Zip Code:98339-1421
Mailing Address - Country:US
Mailing Address - Phone:425-780-3131
Mailing Address - Fax:
Practice Address - Street 1:112 KALA SQUARE PL STE 2
Practice Address - Street 2:
Practice Address - City:PORT TOWNSEND
Practice Address - State:WA
Practice Address - Zip Code:98368-9810
Practice Address - Country:US
Practice Address - Phone:360-390-5844
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-05-01
Last Update Date:2020-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes175F00000XOther Service ProvidersNaturopathGroup - Single Specialty