| Riverside Wellness, Llc | |
|
167 N 710 W Blackfoot ID 83221-5380 | |
| (208) 417-9638 | |
| Not Available |
| Full Name | Riverside Wellness, Llc |
|---|---|
| Speciality | Social Worker - Clinical |
| Location | 167 N 710 W, Blackfoot, Idaho |
| Authorized Official Name and Position | Ashton W Holbrook (OWNER) |
| Authorized Official Contact | 2084179638 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Riverside Wellness, Llc 167 N 710 W Blackfoot ID 83221-5380 Ph: (208) 417-9638 | Riverside Wellness, Llc 167 N 710 W Blackfoot ID 83221-5380 Ph: (208) 417-9638 |
| NPI Number | 1750161980 |
|---|---|
| Provider Enumeration Date | 10/04/2023 |
| Last Update Date | 10/04/2023 |
| Certification Date | 10/04/2023 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1750161980 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1041C0700X | Social Worker - Clinical | (* (Not Available)) | Primary |
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