Organization
PATHWAYS OF IDAHO, LLC
Active
Other names
Clarvida
Organization subpart
No
Provider details
NPI number
Authorized official
LINDSEY BOWEN (DIRECTOR OF ADMIN OPS)
(208) 856-0466
Entity
Organization
Contact information
Practice address
545 N BENJAMIN LN STE 185, BOISE, ID 83704-9625
(208) 322-1026
(208) 322-1029
Mailing address
545 N BENJAMIN LN STE 185, BOISE, ID 83704-9625
(208) 322-1026
(208) 322-1029
Taxonomy
Speciality
Code
Description
License number
State
175T00000X
Peer Specialist
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
20004720
MEDICIAD
ID
01
—
ID05400
MEDICARE PIN
ID
Enumeration date
12/28/2022
Last updated
06/20/2024
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