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3649 N Lakeharbor Ln Boise ID 83703-6913 | |
| (435) 553-9822 | |
| (208) 853-5377 |
| Full Name | |
|---|---|
| Speciality | Clinic/Center |
| Location | 3649 N Lakeharbor Ln, Boise, Idaho |
| Authorized Official Name and Position | Rick Adolpho (OWNER) |
| Authorized Official Contact | 4355539822 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
3649 N Lakeharbor Ln Boise ID 83703-6913 Ph: (435) 553-9822 | 3649 N Lakeharbor Ln Boise ID 83703-6913 Ph: (435) 553-9822 |
| NPI Number | 1932454642 |
|---|---|
| Provider Enumeration Date | 07/18/2012 |
| Last Update Date | 05/23/2024 |
| Certification Date | 05/23/2024 |
| Medicare PECOS PAC ID | 1254552581 |
|---|---|
| Medicare Enrollment ID | O20141029001984 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1932454642 | NPI | - | NPPES |
| 1932454642 | Medicaid | ID |
| Provider Name | Jeffrey C Haskell |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1073535506 PECOS PAC ID: 6709067135 Enrollment ID: I20110218000114 |
| Provider Name | Jane E Krumm |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1578559308 PECOS PAC ID: 9830342740 Enrollment ID: I20121228000375 |
| Provider Name | Ronald K Sebreros |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1386901627 PECOS PAC ID: 2062738792 Enrollment ID: I20150224000703 |
| Provider Name | Aaron Ashby Harris |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1669480091 PECOS PAC ID: 3072751593 Enrollment ID: I20181129001929 |
| Provider Name | Janeil Erb |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1770986531 PECOS PAC ID: 8527437052 Enrollment ID: I20221206000610 |
| Provider Name | Leslie Barton |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1467586073 PECOS PAC ID: 7012368004 Enrollment ID: I20240918001464 |
| Provider Name | William Kelly Hill |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1811256852 PECOS PAC ID: 5597206417 Enrollment ID: I20240919000300 |
| Provider Name | Jennifer Leslie Gallup |
|---|---|
| Provider Type | Practitioner - Other (non-physician) |
| Provider Identifiers | NPI Number: 1609648807 PECOS PAC ID: 7214478981 Enrollment ID: I20240920002963 |
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