# ST LUKE'S ELKS CHILDRENS REHABILITATION

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

## Provider details

- **NPI number:** 1942616073
- **Authorized official:** KAVITA PATIL (MERIDIAN SITE MANAGER)
- **Authorized official phone:** (208) 489-5099

## Contact information

- **Practice address:** 3525 E LOUISE DR, SUITE 255, MERIDIAN, ID 83642-6302
- **Practice address phone:** (208) 489-5099
- **Mailing address:** 3525 E LOUISE DR, SUITE 255, MERIDIAN, ID 83642-6302
- **Mailing address phone:** (208) 489-5099

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 261QR0400X | Rehabilitation Clinic/Center | OT-963 | ID | Yes |

## Other

- **Enumeration date:** 07/09/2014
- **Last updated:** 07/09/2014