Organization
LEAN ON ME AGENCY
Active
Other names
Lean On Me inc.
Organization subpart
No
Provider details
NPI number
Authorized official
WASCAR CRUZ BS (OWNER)
(208) 200-4494
Entity
Organization
Contact information
Practice address
3330 HANDLEY AVE, IDAHO FALLS, ID 83404-7226
(208) 200-4494
Mailing address
3330 HANDLEY AVE, IDAHO FALLS, ID 83404-7226
(208) 200-4494
Taxonomy
Speciality
Code
Description
License number
State
251B00000X
Case Management Agency
—
—
251S00000X
Community/Behavioral Health Agency
Primary
—
—
261QM0801X
Mental Health Clinic/Center (Including Community Mental Health Center)
—
—
261QM0850X
Adult Mental Health Clinic/Center
—
—
261QM0855X
Adolescent and Children Mental Health Clinic/Center
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
A0000588
—
ID
Enumeration date
05/21/2012
Last updated
05/21/2012
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