Provider Demographics
NPI:1730788092
Name:INTERRA HEALTH, INC
Entity type:Organization
Organization Name:INTERRA HEALTH, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:IMPLEMENTATION & TRAINING COORD
Authorized Official - Prefix:
Authorized Official - First Name:MICHELLE
Authorized Official - Middle Name:D
Authorized Official - Last Name:RUTH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:262-330-2827
Mailing Address - Street 1:8919 W HEATHER AVE
Mailing Address - Street 2:
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53224-2417
Mailing Address - Country:US
Mailing Address - Phone:262-330-2827
Mailing Address - Fax:414-375-1623
Practice Address - Street 1:4553 PLEASANT HILL RD
Practice Address - Street 2:
Practice Address - City:KISSIMMEE
Practice Address - State:FL
Practice Address - Zip Code:34759-3422
Practice Address - Country:US
Practice Address - Phone:407-483-5757
Practice Address - Fax:855-642-2122
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-10-19
Last Update Date:2020-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center