Organization
EAGLE CREST LIFE SERVICES INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
ROBERT K WHEELER (OWNER)
(208) 666-9162
Entity
Organization
Contact information
Practice address
212 S 11TH ST STE 3, COEUR D ALENE, ID 83814-4000
(208) 666-9162
Mailing address
PO BOX 3723, COEUR D ALENE, ID 83816-2529
(208) 666-9162
Taxonomy
Speciality
Code
Description
License number
State
2084P0800X
Psychiatry Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
807336200
—
ID
Enumeration date
06/03/2008
Last updated
02/20/2009
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