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Organization
GENESIS SERVICE DOGS INC
Active
Organization
GENESIS SERVICE DOGS INC
Active
Other names
Genesis Service Dogs INC
Organization subpart
No
Provider details
NPI number
Authorized official
MS. DANIELLE STEM (PRESIDENT)
(208) 761-4884
Entity
Organization
Contact information
Practice address
621 W BROADWAY AVE, MERIDIAN, ID 83642-2404
(208) 761-4884
Mailing address
621 W BROADWAY AVE, MERIDIAN, ID 83642-2404
(208) 761-4884
Taxonomy
Speciality
Code
Description
License number
State
332BC3200X
Customized Equipment (DME)
Primary
—
—
335E00000X
Prosthetic/Orthotic Supplier
—
—
Other
Enumeration date
07/17/2012
Last updated
07/17/2012
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