Organization
IDAHO RECOVERY CENTER, LLC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MATTHEW SMITH DIRECTOR (EXECUTIVE DIRECTOR)
(208) 534-8303
Entity
Organization
Contact information
Practice address
771 SOUTH WOODRUFF AVENUE, IDAHO FALLS, ID 83401
(208) 534-8303
Mailing address
3270 E 17TH ST # 261, AMMON, ID 83406-6758
(208) 534-8303
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
—
—
101YM0800X
Mental Health Counselor
Primary
—
—
Other
Enumeration date
08/26/2019
Last updated
08/26/2019
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