Provider Demographics
NPI:1427501840
Name:NW NATURAL HEALTHCARE LLC
Entity type:Organization
Organization Name:NW NATURAL HEALTHCARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MISS
Authorized Official - First Name:LORETTA
Authorized Official - Middle Name:JANE
Authorized Official - Last Name:TYE
Authorized Official - Suffix:
Authorized Official - Credentials:LMT
Authorized Official - Phone:208-743-1974
Mailing Address - Street 1:1114 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:LEWISTON
Mailing Address - State:ID
Mailing Address - Zip Code:83501-1902
Mailing Address - Country:US
Mailing Address - Phone:208-743-1974
Mailing Address - Fax:
Practice Address - Street 1:1114 MAIN ST
Practice Address - Street 2:
Practice Address - City:LEWISTON
Practice Address - State:ID
Practice Address - Zip Code:83501-1902
Practice Address - Country:US
Practice Address - Phone:208-743-1974
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-08-02
Last Update Date:2016-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Multi-Specialty