Healthcare Provider Details

I. General information

NPI: 1083419287
Provider Name (Legal Business Name): SACRED SOL HEALING INSTITUTE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/13/2025
Last Update Date: 04/10/2026
Certification Date: 04/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

501 MAIN ST STE 301
KLAMATH FALLS OR
97601-6056
US

IV. Provider business mailing address

PO BOX 1694
KLAMATH FALLS OR
97601-0095
US

V. Phone/Fax

Practice location:
  • Phone: 541-281-9330
  • Fax: 541-205-6000
Mailing address:
  • Phone: 541-281-9330
  • Fax: 541-205-6000

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code324500000X
TaxonomySubstance Abuse Rehabilitation Facility
License Number
License Number State

VIII. Authorized Official

Name: RENEE FRYE
Title or Position: OWNER
Credential: CRM, PSS, CADC, QMHA
Phone: 541-281-9330