Organization
PROVENTURES LLC
Active
Other names
Side by Side Family Services
Organization subpart
No
Provider details
NPI number
Authorized official
PATRICK DUFFIN (GENERAL MANAGER/ADMINISTRATOR)
(208) 419-5110
Entity
Organization
Contact information
Practice address
1422 E 17TH ST, SUITE A, IDAHO FALLS, ID 83404-6285
(208) 419-5110
Mailing address
6302 E SHARPTAIL RD, IDAHO FALLS, ID 83401-5922
(208) 419-5110
Taxonomy
Speciality
Code
Description
License number
State
251S00000X
Community/Behavioral Health Agency
Primary
—
—
Other
Enumeration date
04/09/2013
Last updated
04/09/2013
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