Organization
MAITRI COMMUNITY SERVICES
Active
Organization subpart
No
Provider details
NPI number
Authorized official
LORI NICOLE EATON LCSW (OWNER/PROVIDER)
(208) 957-5360
Entity
Organization
Contact information
Practice address
3709 N LOCUST GROVE RD, SUITE 100, MERIDIAN, ID 83646-6449
(208) 957-5360
(208) 493-4331
Mailing address
3709 N LOCUST GROVE RD, SUITE 100, MERIDIAN, ID 83646-6449
(208) 957-5360
(208) 493-4331
Taxonomy
Speciality
Code
Description
License number
State
251S00000X
Community/Behavioral Health Agency
Primary
31259
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
806968300
—
ID
Enumeration date
07/20/2016
Last updated
07/20/2016
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