Healthcare Provider Details

I. General information

NPI: 1285630335
Provider Name (Legal Business Name): WARM SPRINGS HEALTH AND WELLNESS CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/23/2005
Last Update Date: 06/20/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1270 KOT-NUM ROAD
WARM SPRINGS OR
97761
US

IV. Provider business mailing address

1270 KOT-NUM ROAD
WARM SPRINGS OR
97761
US

V. Phone/Fax

Practice location:
  • Phone: 541-553-1196
  • Fax: 541-553-2135
Mailing address:
  • Phone: 541-553-1196
  • Fax: 541-553-2135

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MS. DEBORAH ANNE JACKSON-ALVAREZ
Title or Position: BUSINESS OFFICE MANAGER
Credential:
Phone: 541-553-1196