Provider Demographics
NPI:1316130529
Name:HEALTHWISE INC.
Entity type:Organization
Organization Name:HEALTHWISE INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROGRAM DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:SANDRA
Authorized Official - Middle Name:JANE
Authorized Official - Last Name:PETTY
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:541-389-7211
Mailing Address - Street 1:PO BOX 8525
Mailing Address - Street 2:
Mailing Address - City:BEND
Mailing Address - State:OR
Mailing Address - Zip Code:97708-8525
Mailing Address - Country:US
Mailing Address - Phone:541-389-7211
Mailing Address - Fax:541-749-4249
Practice Address - Street 1:2753 NW LOLO DR
Practice Address - Street 2:SUITE 200
Practice Address - City:BEND
Practice Address - State:OR
Practice Address - Zip Code:97701-7288
Practice Address - Country:US
Practice Address - Phone:541-389-7211
Practice Address - Fax:541-749-4249
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-21
Last Update Date:2011-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
ORP00436523Medicare PIN
OR0000PHNCPMedicare PIN
080100568Medicare PIN
ORR0000PHNCPMedicare PIN