Healthcare Provider Details

I. General information

NPI: 1851261960
Provider Name (Legal Business Name): RELATYV MOBILE MEDICAL LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/05/2025
Last Update Date: 02/11/2026
Certification Date: 02/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2107 LITTLE APPLEGATE RD
JACKSONVILLE OR
97530-9188
US

IV. Provider business mailing address

4140 E BASELINE RD STE 101 STE 101
MESA AZ
85206-4413
US

V. Phone/Fax

Practice location:
  • Phone: 866-914-1070
  • Fax: 800-852-6567
Mailing address:
  • Phone: 830-832-9703
  • Fax: 877-285-0470

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TF0000X
TaxonomyFamily Psychologist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code246Z00000X
TaxonomyOther Specialist/Technologist
License Number
License Number State

VIII. Authorized Official

Name: JANICE A COMPTON
Title or Position: CONTRACTING
Credential:
Phone: 830-832-9703