Provider Demographics
NPI:1528511474
Name:GOOD RIVER NATUROPATHIC, LLC
Entity type:Organization
Organization Name:GOOD RIVER NATUROPATHIC, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:TUCKER
Authorized Official - Middle Name:S
Authorized Official - Last Name:MEAGER
Authorized Official - Suffix:
Authorized Official - Credentials:ND
Authorized Official - Phone:541-971-4110
Mailing Address - Street 1:PO BOX 1511
Mailing Address - Street 2:
Mailing Address - City:HOOD RIVER
Mailing Address - State:OR
Mailing Address - Zip Code:97031-0511
Mailing Address - Country:US
Mailing Address - Phone:541-971-4110
Mailing Address - Fax:541-971-4110
Practice Address - Street 1:202 STATE ST
Practice Address - Street 2:STE 6
Practice Address - City:HOOD RIVER
Practice Address - State:OR
Practice Address - Zip Code:97031-2036
Practice Address - Country:US
Practice Address - Phone:541-971-4110
Practice Address - Fax:541-971-4110
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-07-27
Last Update Date:2016-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QC1500XAmbulatory Health Care FacilitiesClinic/CenterCommunity Health
No261QC1800XAmbulatory Health Care FacilitiesClinic/CenterCorporate Health