Organization
EAGLE CREST LIFE SERVICES, INC.
Active
Other names
ECLS
Organization subpart
No
Provider details
NPI number
Authorized official
MR. ROBERT WHEELER BA (PRESIDENT)
(208) 666-9162
Entity
Organization
Contact information
Practice address
212 S 11TH ST, STE. 3, COEUR D ALENE, ID 83814-4000
(208) 666-9162
(208) 769-9321
Mailing address
PO BOX 3723, COEUR D ALENE, ID 83816-2529
(208) 666-9162
(208) 769-9321
Taxonomy
Speciality
Code
Description
License number
State
251S00000X
Community/Behavioral Health Agency
Primary
807602900
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
807602900
—
ID
Enumeration date
04/02/2007
Last updated
03/13/2009
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