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General NPI Number Information
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NPI Number | 1598373870
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Entity Type | Organization
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Legal Business Name | INNOVATIVE HEALTH & WELLNESS LLC 2
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Dates
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Enumeration Date | 07/22/2020
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Last Update Date | 07/22/2020
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Provider Practice Location Address
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Address Line | 2300 HUMBUG CREEK RD
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City | JACKSONVILLE
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State | OR
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Zip | 97530-9617
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Country | US
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Telephone | 702-522-7363
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Fax |
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Provider Business Mailing Address
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Address Line | 2300 HUMBUG CREEK RD
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City | JACKSONVILLE
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State | OR
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Zip | 97530-9617
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Country | US
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Telephone | 702-522-7363
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | CARLOS R POLLARD
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Credential |
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Telephone | 702-324-2126
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 172V00000X
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Taxonomy Name | Community Health Worker
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number |
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License Number State |
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