Organization
PASSPORT TO INDEPENDENCE,LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. MICHAEL ANTHONY TRIOLO RPH (BUSINESS MANAGER)
(208) 461-4882
Entity
Organization
Contact information
Practice address
764 W HEATHER WOODS DR, NAMPA, ID 83686-2685
(208) 461-4882
Mailing address
764 W HEATHER WOODS DR, NAMPA, ID 83686-2685
(208) 461-4882
Taxonomy
Speciality
Code
Description
License number
State
261QX0100X
Occupational Medicine Clinic/Center
Primary
OT808
ID
Other
Enumeration date
05/20/2008
Last updated
05/20/2008
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