Provider Demographics
NPI:1932588084
Name:HEALTHY LIFESTYLE RESOURCE CENTER
Entity type:Organization
Organization Name:HEALTHY LIFESTYLE RESOURCE CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:HLRC PROGRAM DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:KRISTIN
Authorized Official - Middle Name:
Authorized Official - Last Name:GYFORD
Authorized Official - Suffix:
Authorized Official - Credentials:LMSW
Authorized Official - Phone:541-749-8236
Mailing Address - Street 1:2525 NE TWIN KNOLLS DR
Mailing Address - Street 2:
Mailing Address - City:BEND
Mailing Address - State:OR
Mailing Address - Zip Code:97701-5275
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2525 NE TWIN KNOLLS DR STE 9
Practice Address - Street 2:
Practice Address - City:BEND
Practice Address - State:OR
Practice Address - Zip Code:97701-5264
Practice Address - Country:US
Practice Address - Phone:541-749-8236
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-05-21
Last Update Date:2015-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORM6177251B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management