Organization
GENESIS SERVICE DOGS INC
Active
Other names
Genesis Service Dogs INC
Organization subpart
No
Provider details
NPI number
Authorized official
MS. DANIELLE STEM (PRESIDENT)
(208) 761-4884
Entity
Organization
Contact information
Practice address
621 W BROADWAY AVE, MERIDIAN, ID 83642-2404
(208) 761-4884
Mailing address
621 W BROADWAY AVE, MERIDIAN, ID 83642-2404
(208) 761-4884
Taxonomy
Speciality
Code
Description
License number
State
332BC3200X
Customized Equipment (DME)
Primary
—
—
335E00000X
Prosthetic/Orthotic Supplier
—
—
Other
Enumeration date
07/17/2012
Last updated
07/17/2012
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