Healthcare Provider Details

I. General information

NPI: 1801347703
Provider Name (Legal Business Name): TIDES TREATMENT SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/17/2016
Last Update Date: 10/17/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

600 N CURTIS RD SUITE 245
BOISE ID
83706-1449
US

IV. Provider business mailing address

600 N CURTIS RD SUITE 245
BOISE ID
83706-1449
US

V. Phone/Fax

Practice location:
  • Phone: 208-672-0360
  • Fax:
Mailing address:
  • Phone: 208-672-0360
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number State

VIII. Authorized Official

Name: AMY SALISBURY
Title or Position: CO-OWNER
Credential: CADC
Phone: 208-672-0360