Provider Demographics
NPI:1528513835
Name:THE HEALTHY LIVING CENTER FOUNDATION C/O PRIMARY CARE SPECIALISTS, INC
Entity type:Organization
Organization Name:THE HEALTHY LIVING CENTER FOUNDATION C/O PRIMARY CARE SPECIALISTS, INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:OLIVIA
Authorized Official - Middle Name:M
Authorized Official - Last Name:NEWBY
Authorized Official - Suffix:
Authorized Official - Credentials:DNP, FNP-BC, CDE
Authorized Official - Phone:757-622-0542
Mailing Address - Street 1:930 MAJESTIC AVENUE
Mailing Address - Street 2:SUITE 110
Mailing Address - City:NORFOLK
Mailing Address - State:VA
Mailing Address - Zip Code:23504
Mailing Address - Country:US
Mailing Address - Phone:757-622-0542
Mailing Address - Fax:757-627-5809
Practice Address - Street 1:930 MAJESTIC AVENUE
Practice Address - Street 2:SUITE 110
Practice Address - City:NORFOLK
Practice Address - State:VA
Practice Address - Zip Code:23504
Practice Address - Country:US
Practice Address - Phone:757-622-0542
Practice Address - Fax:757-627-5809
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-08-17
Last Update Date:2017-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes305R00000XManaged Care OrganizationsPreferred Provider Organization