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1363 Fillmore St Twin Falls ID 83301-3392 | |
| (208) 736-7090 | |
| Not Available |
| Full Name | |
|---|---|
| Speciality | Community/behavioral Health |
| Location | 1363 Fillmore St, Twin Falls, Idaho |
| Authorized Official Name and Position | Jennie Rebecca Fullmer (OWNER) |
| Authorized Official Contact | 2087367090 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
1363 Fillmore St Twin Falls ID 83301-3392 Ph: (208) 736-7090 | 1363 Fillmore St Twin Falls ID 83301-3392 Ph: (208) 736-7090 |
| NPI Number | 1235457565 |
|---|---|
| Provider Enumeration Date | 05/11/2010 |
| Last Update Date | 03/30/2015 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1235457565 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 251S00000X | Community/behavioral Health | (* (Not Available)) | Primary |
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