Organization
NORTHSIDE COUNSELING AND REHAB
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MS. MARYLIN EACKER LSW (MANAGING MEMBER)
(208) 731-5750
Entity
Organization
Contact information
Practice address
801 N LINCOLN AVE, JEROME, ID 83338-1853
(208) 731-5750
Mailing address
801 N LINCOLN AVE, JEROME, ID 83338-1853
(208) 731-5750
Taxonomy
Speciality
Code
Description
License number
State
251S00000X
Community/Behavioral Health Agency
Primary
—
—
Other
Enumeration date
11/28/2008
Last updated
11/28/2008
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