Specialty |
Taxonomy Code | Specialty Code | Provider Type | |
Pastoral |
101YP1600X | |||
Addiction (Substance Use Disorder) |
101YA0400X | |||
Case Manager/Care Coordinator |
171M00000X | |||
Interpreter |
171R00000X | |||
Other Service Providers |
175T00000X |
| NPI # | 1386476380 |
| LBN Legal business name | RESTORATION WELLNESS OF IDAHO LLC |
| Authorized official | MELANIE LONG-AZARY - (OWNER) |
| Entity | Organization |
| Organization subpart 1 | No |
| Enumeration date | 08/17/2024 |
| Last updated | 08/17/2024 - More than a year ago |
| Identifiers | n/a |
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