# PASSPORT TO INDEPENDENCE,LLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1275790081
- **Authorized official:** MR. MICHAEL ANTHONY TRIOLO RPH (BUSINESS MANAGER)
- **Authorized official phone:** (208) 461-4882

## Contact information

- **Practice address:** 764 W HEATHER WOODS DR, NAMPA, ID 83686-2685
- **Practice address phone:** (208) 461-4882
- **Mailing address:** 764 W HEATHER WOODS DR, NAMPA, ID 83686-2685
- **Mailing address phone:** (208) 461-4882

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 261QX0100X | Occupational Medicine Clinic/Center | OT808 | ID | Yes |

## Other

- **Enumeration date:** 05/20/2008
- **Last updated:** 05/20/2008