Organization
EAGLE CREST LIFE SERVICES
Active
Organization subpart
No
Provider details
NPI number
Authorized official
ROBERT WHEELER BA (PRESIDENT)
(208) 666-9162
Entity
Organization
Contact information
Practice address
212 S 11TH ST, STE. 3, COEUR D ALENE, ID 83814-4000
(208) 666-9162
(208) 769-9321
Mailing address
PO BOX 3723, COEUR D ALENE, ID 83816-2529
(208) 666-9162
(208) 769-9321
Taxonomy
Speciality
Code
Description
License number
State
251B00000X
Case Management Agency
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
8076030
—
ID
Enumeration date
05/15/2007
Last updated
03/13/2009
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