Organization
LOST RIVER WELLNESS
Active
Other names
Lost River Wellness
Organization subpart
No
Provider details
NPI number
Authorized official
JEFF BROWN (CHIEF BUSINESS OFFICER)
(208) 484-1447
Entity
Organization
Contact information
Practice address
3080 E GENTRY WAY STE 100, MERIDIAN, ID 83642-3060
(208) 810-2318
Mailing address
3080 E GENTRY WAY STE 100, MERIDIAN, ID 83642-3060
(208) 484-1447
Taxonomy
Speciality
Code
Description
License number
State
261QM0850X
Adult Mental Health Clinic/Center
Primary
M11538
ID
Other
Enumeration date
08/18/2018
Last updated
11/28/2018
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