| Mana Resources Llc | |
|
1008 Fillmore St Caldwell ID 83605-4129 | |
| (208) 585-3375 | |
| (208) 585-6152 |
| Full Name | Mana Resources Llc |
|---|---|
| Speciality | Community/Behavioral Health |
| Location | 1008 Fillmore St, Caldwell, Idaho |
| Authorized Official Name and Position | Jennifer Ah You (PROGRAM DIRECTOR) |
| Authorized Official Contact | 2085853375 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Mana Resources Llc 1008 Fillmore St Caldwell ID 83605-4129 Ph: (208) 585-3375 | Mana Resources Llc 1008 Fillmore St Caldwell ID 83605-4129 Ph: (208) 585-3375 |
| NPI Number | 1366883605 |
|---|---|
| Provider Enumeration Date | 07/15/2013 |
| Last Update Date | 10/03/2013 |
| Medicare PECOS PAC ID | 1759793490 |
|---|---|
| Medicare Enrollment ID | O20210318001570 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1366883605 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 251S00000X | Community/behavioral Health | (* (Not Available)) | Primary |
| Provider Name | Taylor A Barrera |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1023572740 PECOS PAC ID: 5092186171 Enrollment ID: I20230127002141 |
| Provider Name | Sean J Nixon |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1003167198 PECOS PAC ID: 6406295104 Enrollment ID: I20240415001185 |
| Provider Name | Kathy Joan Edwards |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1174986905 PECOS PAC ID: 2466865837 Enrollment ID: I20240502002480 |
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