Individual
EVAN WHITE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
9825 MAYBERRY LN, EMMETT, ID 83617-3051
(208) 713-1290
Mailing address
9825 MAYBERRY LN, EMMETT, ID 83617-3051
(208) 713-1290
Taxonomy
Speciality
Code
Description
License number
State
320900000X
Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
Primary
—
—
Other
Enumeration date
09/27/2024
Last updated
09/27/2024
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