| Healing Hub Llc | |
|
8677 N Wayne Dr Ste B Hayden ID 83835-5190 | |
| (208) 691-0691 | |
| Not Available |
| Full Name | Healing Hub Llc |
|---|---|
| Speciality | Counselor |
| Location | 8677 N Wayne Dr Ste B, Hayden, Idaho |
| Authorized Official Name and Position | Ashton Underdahl (CO-OWNER) |
| Authorized Official Contact | 2086910691 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Healing Hub Llc 2680 E Hayden View Dr Coeur D Alene ID 83815-7038 Ph: (208) 691-0691 | Healing Hub Llc 8677 N Wayne Dr Ste B Hayden ID 83835-5190 Ph: (208) 691-0691 |
| NPI Number | 1407549041 |
|---|---|
| Provider Enumeration Date | 05/30/2023 |
| Last Update Date | 05/30/2023 |
| Certification Date | 05/30/2023 |
| Medicare PECOS PAC ID | 4385089135 |
|---|---|
| Medicare Enrollment ID | O20240301003657 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1407549041 | NPI | - | NPPES |
| 1669956686 | Medicaid | ID |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 101YP2500X | Counselor - Professional | (* (Not Available)) | Primary |
| Provider Name | Andrea K Rice |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1669956686 PECOS PAC ID: 3577906916 Enrollment ID: I20240213001429 |
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