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Organization
OAK TREE SUPPORTED LIVING
Active
Organization
OAK TREE SUPPORTED LIVING
Active
Organization subpart
No
Provider details
NPI number
Authorized official
HEIDI PROVENCE (OWNER/ADMINISTRATOR)
(208) 620-1477
Entity
Organization
Contact information
Practice address
522 W RIVERSIDE AVE, SPOKANE, WA 99201-0580
(208) 620-1477
Mailing address
1390 E ELDERBERRY CIR, COEUR D ALENE, ID 83815-6559
(208) 620-1477
Taxonomy
Speciality
Code
Description
License number
State
251S00000X
Community/Behavioral Health Agency
—
NULL
320600000X
Intellectual and/or Developmental Disabilities Residential Treatment Facility
Primary
—
NULL
Other
Enumeration date
08/24/2026
Last updated
08/24/2026
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