Healthcare Provider Details

I. General information

NPI: 1801587209
Provider Name (Legal Business Name): WELL AWARE INTEGRATIVE CARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/16/2023
Last Update Date: 05/16/2023
Certification Date: 05/16/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

132 E BROADWAY STE 303
EUGENE OR
97401-3154
US

IV. Provider business mailing address

132 E BROADWAY STE 303
EUGENE OR
97401-3154
US

V. Phone/Fax

Practice location:
  • Phone: 541-525-4460
  • Fax:
Mailing address:
  • Phone: 541-525-4460
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: CHRIS WHITE
Title or Position: MEMBER
Credential: MD
Phone: 707-499-2226