# COPACETIC SUPPORTED LIVING

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

## Provider details

- **NPI number:** 1316734296
- **Authorized official:** RILEY CASTILLO (OWNER/OPERATOR)
- **Authorized official phone:** (208) 297-0811

## Contact information

- **Practice address:** 540 S 16TH ST STE 112, PAYETTE, ID 83661-3514
- **Practice address phone:** (208) 297-0811
- **Mailing address:** 540 S 16TH ST STE 112, PAYETTE, ID 83661-3514
- **Mailing address phone:** (208) 297-0811

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 253Z00000X | In Home Supportive Care Agency | — | NULL | Yes |

## Other

- **Enumeration date:** 04/23/2025
- **Last updated:** 04/23/2025