| Legacy Village Outpatient Id, Llc | |
|
800 W Main St Ste 1460 Boise ID 83702-5983 | |
| (800) 997-6977 | |
| (661) 489-0573 |
| Full Name | Legacy Village Outpatient Id, Llc |
|---|---|
| Speciality | Substance Abuse Rehabilitation Facility |
| Location | 800 W Main St Ste 1460, Boise, Idaho |
| Authorized Official Name and Position | Dennis Scott Farmer (CHIEF EXECUTIVE OFFICER) |
| Authorized Official Contact | 8009976977 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Legacy Village Outpatient Id, Llc 800 W Main St Ste 1460 Boise ID 83702-5983 Ph: (800) 997-6977 | Legacy Village Outpatient Id, Llc 800 W Main St Ste 1460 Boise ID 83702-5983 Ph: (800) 997-6977 |
| NPI Number | 1225721707 |
|---|---|
| Provider Enumeration Date | 05/31/2023 |
| Last Update Date | 05/31/2023 |
| Certification Date | 05/31/2023 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1225721707 | NPI | - | NPPES |
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