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General NPI Number Information
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NPI Number | 1669605424
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Entity Type | Organization
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Legal Business Name | AZALEA FAMILY HEALTH CARE LLC
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Dates
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Enumeration Date | 08/27/2009
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Last Update Date | 08/27/2009
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Provider Practice Location Address
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Address Line | 937 CHETCO AVE.
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City | BROOKINGS
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State | OR
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Zip | 97415
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Country | US
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Telephone | 541-469-1919
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Fax | 541-469-4949
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Provider Business Mailing Address
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Address Line | PO BOX 7706
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City | BROOKINGS
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State | OR
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Zip | 97415-0366
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Country | US
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Telephone | 541-469-1919
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Fax | 541-469-4949
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Authorized Official
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Title or Position | OWNER
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Name | FRANCES E GUTHRIDGE
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Credential | FNP
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Telephone | 541-469-0402
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2300X
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Taxonomy Name | Primary Care Clinic/Center
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License Number |
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License Number State |
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