Organization
AFFIRMATIVE SUPPORT SERVICES & COORDINATION
Active
Organization subpart
No
Provider details
NPI number
Authorized official
SHERRY LYNN GREENUP (OWNER/ADMINISTRATOR)
(208) 743-1971
Entity
Organization
Contact information
Practice address
3629 18TH ST, LEWISTON, ID 83501-5972
(208) 743-1971
(208) 746-1458
Mailing address
PO BOX 1124, LEWISTON, ID 83501-1124
(208) 743-1971
(208) 746-1458
Taxonomy
Speciality
Code
Description
License number
State
251B00000X
Case Management Agency
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
807846900
—
ID
05
—
807847500
—
ID
Enumeration date
10/10/2007
Last updated
10/10/2007
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