Organization
HEALING ROOTS MEDICINE LLC
Active
Other names
Hearthside Medicine Family Care, Healing Roots Medicine, Hearthside Medicine Family Care
Organization subpart
No
Provider details
NPI number
Authorized official
HAVILAH NOEL BRODHEAD (OWNER)
(541) 316-5693
Entity
Organization
Contact information
Practice address
339 SW CENTURY DR STE 201, BEND, OR 97702-1338
(541) 316-5693
Mailing address
339 SW CENTURY DR STE 201, BEND, OR 97702-1338
(541) 316-5693
(541) 255-0947
Taxonomy
Speciality
Code
Description
License number
State
261QP2300X
Primary Care Clinic/Center
Primary
201407546NP-PP
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
500678393
—
OR
05
—
500752671
—
OR
Enumeration date
02/01/2018
Last updated
07/06/2026
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