Healthcare Provider Details

I. General information

NPI: 1801452677
Provider Name (Legal Business Name): ASHWOOD RECOVERY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/16/2019
Last Update Date: 06/25/2024
Certification Date: 06/25/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7941 W RIFLEMAN ST
BOISE ID
83704-9001
US

IV. Provider business mailing address

3515 E OVERLAND RD
MERIDIAN ID
83642-6757
US

V. Phone/Fax

Practice location:
  • Phone: 208-895-7950
  • Fax:
Mailing address:
  • Phone: 208-605-7070
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM0855X
TaxonomyAdolescent and Children Mental Health Clinic/Center
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code261QR0405X
TaxonomySubstance Use Disorder Rehabilitation Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: KRISTA GILBERT
Title or Position: CEO
Credential:
Phone: 208-810-2704