Organization
PHIL WAGGONER
Active
Other names
Riverside Recovery
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. DANA K BOYD (BUSINESS OFC MANAGER OWNER)
(208) 746-4097
Entity
Organization
Contact information
Practice address
1720 18TH AVE, LEWISTON, ID 83501-4047
(208) 746-4097
(208) 746-2294
Mailing address
1720 18TH AVE, LEWISTON, ID 83501
(208) 746-4097
(208) 746-2294
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
138
ID
Other
Enumeration date
12/05/2006
Last updated
08/22/2020
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