| Dragonfly Support Services, Llc. | |
|
1105 W Ironwood Dr Lowr Level Coeur D Alene ID 83814-2613 | |
| (208) 676-1075 | |
| Not Available |
| Full Name | Dragonfly Support Services, Llc. |
|---|---|
| Speciality | Social Worker |
| Location | 1105 W Ironwood Dr Lowr Level, Coeur D Alene, Idaho |
| Authorized Official Name and Position | Bailey J White (MEMBER) |
| Authorized Official Contact | 2086911251 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Dragonfly Support Services, Llc. Po Box 207 Post Falls ID 83877-0207 Ph: () - | Dragonfly Support Services, Llc. 1105 W Ironwood Dr Lowr Level Coeur D Alene ID 83814-2613 Ph: (208) 676-1075 |
| NPI Number | 1538645155 |
|---|---|
| Provider Enumeration Date | 07/17/2018 |
| Last Update Date | 07/17/2018 |
| Medicare PECOS PAC ID | 9436409042 |
|---|---|
| Medicare Enrollment ID | O20180831001288 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1538645155 | NPI | - | NPPES |
| Provider Name | Bailey J White |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1912348186 PECOS PAC ID: 1557669843 Enrollment ID: I20160420001107 |
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