Individual
JEREMY AJETI
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
BS
Contact information
Practice address
630 ADDISON AVE W STE 1000, TWIN FALLS, ID 83301-5853
(208) 736-5048
(208) 735-2126
Mailing address
630 ADDISON AVE W STE 1000, TWIN FALLS, ID 83301-5853
(208) 736-5048
(208) 735-2126
Taxonomy
Speciality
Code
Description
License number
State
251B00000X
Case Management Agency
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2786392228
TREATMENT AND RECOVERY CENTER
ID
Enumeration date
07/28/2021
Last updated
07/28/2021
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