# TRI-STATE HEALING INITIATIVE LLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1841984036
- **Authorized official:** BRYCE RATLIFF MD (OWNER)
- **Authorized official phone:** (952) 261-7105

## Contact information

- **Practice address:** 1619 DIEDERICH BLVD STE D1, RUSSELL, KY 41169-1778
- **Practice address phone:** (952) 261-7105
- **Mailing address:** 17 LACKAWANNA PL APT 318, BLOOMFIELD, NJ 07003-2954

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207Q00000X | Family Medicine Physician | — | NULL | Yes |
| 207Q00000X | Family Medicine Physician | — | — | Yes |

## Other

- **Enumeration date:** 06/08/2023
- **Last updated:** 06/17/2025