Individual
BRENDA ELAINE DILBECK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
4515 N GLENWOOD ST, BOISE, ID 83704-3012
(208) 629-4290
(208) 629-4290
Mailing address
4519 N GLENWOOD ST, BOISE, ID 83704-3012
(208) 323-7514
(208) 323-7514
Taxonomy
Speciality
Code
Description
License number
State
315P00000X
Intellectual Disabilities Intermediate Care Facility
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
M8063096
—
ID
Enumeration date
09/18/2012
Last updated
09/18/2012
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