Healthcare Provider Details

I. General information

NPI: 1669119574
Provider Name (Legal Business Name): ANCORA HEALTH, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/13/2022
Last Update Date: 11/25/2024
Certification Date: 11/25/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

530 SPRING ST
FRIDAY HARBOR WA
98250-8057
US

IV. Provider business mailing address

530 SPRING ST
FRIDAY HARBOR WA
98250-8057
US

V. Phone/Fax

Practice location:
  • Phone: 206-783-2511
  • Fax:
Mailing address:
  • Phone: 360-472-9299
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: MS. AURALEE JAMESON
Title or Position: OWNER
Credential: RN, MSN, LICSW
Phone: 360-472-9299