Organization
LIVING LEGACY HEALTH LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. JOHN RUDOLPH DO (OWNER)
(208) 503-3113
Entity
Organization
Contact information
Practice address
7717 PADDOCK LN, LEWISTON, ID 83501-6291
(208) 503-3113
Mailing address
2320 THAIN GRADE # 1016, LEWISTON, ID 83501-4115
(208) 503-3113
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
—
—
207QG0300X
Geriatric Medicine (Family Medicine) Physician
—
—
Other
Enumeration date
05/25/2023
Last updated
01/02/2024
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