| Organization Name: | INNERCEPT |
| NPI Number: | 1003086653 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | GEORGE JACKSON ULLRICH (MEDICAL DIRECTOR) |
| Mailing Address: | 1115 Ironwood Dr Suite A Coeur D Alene |
| State: | ID US |
| Postal Code: | 838144936 |
| Phone Number: | 2086657178 |
| Fax Number: | 2087656972 |
| NPI Enumeration Date: | 03/10/2008 |
| NPI Last Update Date: | 03/10/2008 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 320800000X |
| License Number: | |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | |
| Taxonomy Type: | Residential Treatment Facilities |
| Taxonomy Classification: | Community Based Residential Treatment Facility, Mental Illness |
| Taxonomy Specialization: | |
| Taxonomy Definition: | A home-like residential facility providing psychiatric treatment and psycho/social rehabilitative services to individuals diagnosed with mental illness. |