Healthcare Provider Details

I. General information

NPI: 1962604942
Provider Name (Legal Business Name): REDDOOR REHABILITATION INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/03/2007
Last Update Date: 12/31/2025
Certification Date: 12/31/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1420 N HIGHWAY 33 STE 203
DRIGGS ID
83422-5316
US

IV. Provider business mailing address

1420 N HIGHWAY 33 STE 203
DRIGGS ID
83422-5316
US

V. Phone/Fax

Practice location:
  • Phone: 208-354-3005
  • Fax: 208-354-3006
Mailing address:
  • Phone: 208-354-3005
  • Fax: 208-354-3006

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number StateID
# 2
Primary TaxonomyY
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MRS. EVITA MARLENE HARRIS
Title or Position: PRESIDENT
Credential: B.A.
Phone: 208-354-3005