Organization
TRI-STATE HEALING INITIATIVE LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
BRYCE RATLIFF MD (OWNER)
(952) 261-7105
Entity
Organization
Contact information
Practice address
1619 DIEDERICH BLVD STE D1, RUSSELL, KY 41169-1778
(952) 261-7105
Mailing address
17 LACKAWANNA PL APT 318, BLOOMFIELD, NJ 07003-2954
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
—
—
Other
Enumeration date
06/08/2023
Last updated
06/17/2025
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