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Organization
BRANDY M BATES LLC
Active
Organization
BRANDY M BATES LLC
Active
Other names
Haven Complete Wellness Services
Organization subpart
No
Provider details
NPI number
Authorized official
BRANDY M BATES DMSC, PA-C, CAQ-PSYC (OWNER/PROVIDER)
(208) 851-9151
Entity
Organization
Contact information
Practice address
2434 S FAIRWAY DR, POCATELLO, ID 83201-2372
(208) 851-9151
(208) 977-0029
Mailing address
2434 S FAIRWAY DR, POCATELLO, ID 83201-2372
(208) 851-9151
(208) 977-0029
Taxonomy
Speciality
Code
Description
License number
State
207QG0300X
Geriatric Medicine (Family Medicine) Physician
Primary
—
NULL
207QG0300X
Geriatric Medicine (Family Medicine) Physician
Primary
—
—
261QM2500X
Medical Specialty Clinic/Center
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
601809507
—
ID
Enumeration date
01/23/2026
Last updated
07/15/2026
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