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General NPI Number Information
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NPI Number | 1932588084
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Entity Type | Organization
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Legal Business Name | HEALTHY LIFESTYLE RESOURCE CENTER
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Dates
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Enumeration Date | 05/21/2015
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Last Update Date | 05/21/2015
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Provider Practice Location Address
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Address Line | 2525 NE TWIN KNOLLS DR STE 9
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City | BEND
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State | OR
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Zip | 97701-5264
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Country | US
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Telephone | 541-749-8236
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Fax |
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Provider Business Mailing Address
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Address Line | 2525 NE TWIN KNOLLS DR
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City | BEND
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State | OR
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Zip | 97701-5275
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | HLRC PROGRAM DIRECTOR
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Name | MRS. KRISTIN GYFORD
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Credential | LMSW
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Telephone | 541-749-8236
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251B00000X
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Taxonomy Name | Case Management Agency
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License Number | M6177
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License Number State | OR
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