Organization Name: | LATINO STAND UP IDAHO LLC |
NPI Number: | 1043556608 |
Entity Type Code: | Organizational (2) |
Authorized Official Name: | ROGER HORNE (OWNER) |
Mailing Address: | 1680 Woodruff Park Idaho Falls |
State: | ID US |
Postal Code: | 834013330 |
Phone Number: | 2085526373 |
Fax Number: | 2085522188 |
NPI Enumeration Date: | 12/28/2012 |
NPI Last Update Date: | 05/23/2013 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 261QM0850X |
License Number: | |
Healthcare Provider Taxonomy: (Secondary) | N |
State: | |
Taxonomy Type: | Ambulatory Health Care Facilities |
Taxonomy Classification: | Clinic/Center |
Taxonomy Specialization: | Adult Mental Health |
Taxonomy Definition: | An entity, facility, or distinct part of a facility providing diagnostic, treatment, and prescriptive services related to mental and behavioral disorders in adults. |