=====================================================
General NPI Number Information
=====================================================
NPI Number | 1548436918
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | A FAMILY HEALING CENTER
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/05/2008
-----------------------------------------------------
Last Update Date | 07/31/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 829 NE HWY 99W
-----------------------------------------------------
City | MCMINNVILLE
-----------------------------------------------------
State | OR
-----------------------------------------------------
Zip | 97128
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 503-883-0333
-----------------------------------------------------
Fax | 503-857-0622
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 829 NE HWY 99W
-----------------------------------------------------
City | MCMINNVILLE
-----------------------------------------------------
State | OR
-----------------------------------------------------
Zip | 97128
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 503-883-0333
-----------------------------------------------------
Fax | 503-857-0622
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER/ MEDICAL DIRECTOR
-----------------------------------------------------
Name | DR. JESSICA BLACK
-----------------------------------------------------
Credential | ND
-----------------------------------------------------
Telephone | 503-883-0333
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 175F00000X
-----------------------------------------------------
Taxonomy Name | Naturopath
-----------------------------------------------------
License Number | 1263
-----------------------------------------------------
License Number State | OR
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 175F00000X
-----------------------------------------------------
Taxonomy Name | Naturopath
-----------------------------------------------------
License Number | 1269
-----------------------------------------------------
License Number State | OR
-----------------------------------------------------