Provider Demographics
NPI:1205295532
Name:SIMPLY HEALTH FOR LIFE, INC.
Entity type:Organization
Organization Name:SIMPLY HEALTH FOR LIFE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:CATHERINE
Authorized Official - Middle Name:ELIZABETH
Authorized Official - Last Name:HUTTON-WIGHTMAN
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:937-623-9883
Mailing Address - Street 1:7059 SHULL RD
Mailing Address - Street 2:
Mailing Address - City:HUBER HEIGHTS
Mailing Address - State:OH
Mailing Address - Zip Code:45424-1230
Mailing Address - Country:US
Mailing Address - Phone:937-623-9883
Mailing Address - Fax:
Practice Address - Street 1:6076 CHAMBERSBURG RD
Practice Address - Street 2:
Practice Address - City:HUBER HEIGHTS
Practice Address - State:OH
Practice Address - Zip Code:45424-3855
Practice Address - Country:US
Practice Address - Phone:937-623-9883
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-02-15
Last Update Date:2016-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH4523261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center