| My Life Alive Llc | |
|
388 State St Suite 705 Salem OR 97301-3866 | |
| (503) 807-3444 | |
| Not Available |
| Full Name | My Life Alive Llc |
|---|---|
| Speciality | Community/behavioral Health |
| Location | 388 State St, Salem, Oregon |
| Authorized Official Name and Position | Carmen Heidecke (COUNSELOR) |
| Authorized Official Contact | 5038073444 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| My Life Alive Llc Po Box 4461 Salem OR 97302-8461 Ph: (503) 807-3444 | My Life Alive Llc 388 State St Suite 705 Salem OR 97301-3866 Ph: (503) 807-3444 |
| NPI Number | 1699129445 |
|---|---|
| Provider Enumeration Date | 04/18/2016 |
| Last Update Date | 04/18/2016 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1699129445 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 251S00000X | Community/behavioral Health | C4060 (Oregon) | Primary |
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