| Lost River Wellness | |
|
3080 E Gentry Way Ste 100 Meridian ID 83642-3060 | |
| (208) 810-2318 | |
| Not Available |
| Full Name | Lost River Wellness |
|---|---|
| Speciality | Clinic/center - Adult Mental Health |
| Location | 3080 E Gentry Way Ste 100, Meridian, Idaho |
| Authorized Official Name and Position | Jeff Brown (CHIEF BUSINESS OFFICER) |
| Authorized Official Contact | 2084841447 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Lost River Wellness 3080 E Gentry Way Ste 100 Meridian ID 83642-3060 Ph: (208) 484-1447 | Lost River Wellness 3080 E Gentry Way Ste 100 Meridian ID 83642-3060 Ph: (208) 810-2318 |
| NPI Number | 1497235469 |
|---|---|
| Provider Enumeration Date | 08/18/2018 |
| Last Update Date | 11/28/2018 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1497235469 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QM0850X | Clinic/center - Adult Mental Health | M11538 (Idaho) | Primary |
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