Organization
BRICK HOUSE RECOVERY
Active
Other names
Brick House Recovery - Coeur D'alene
Organization subpart
No
Provider details
NPI number
Authorized official
JASON D COOMBS MPC (CEO/FOUNDER)
(801) 350-1716
Entity
Organization
Contact information
Practice address
3918 N SCHREIBER WAY STE B, COEUR D ALENE, ID 83815-8395
(801) 350-1716
Mailing address
4727 N HIGH PRAIRIE PL, STAR, ID 83669-5371
(801) 350-1716
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
—
—
251B00000X
Case Management Agency
—
—
261QM0850X
Adult Mental Health Clinic/Center
—
—
261QR0405X
Substance Use Disorder Rehabilitation Clinic/Center
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1770987844
NPI
ID
Enumeration date
09/20/2022
Last updated
09/20/2022
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