Healthcare Provider Details

I. General information

NPI: 1194926774
Provider Name (Legal Business Name): SNAKE RIVER REHABILITATION SERVICES INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/30/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1448 G ST
LEWISTON ID
83501-2004
US

IV. Provider business mailing address

1448 G ST
LEWISTON ID
83501-2004
US

V. Phone/Fax

Practice location:
  • Phone: 208-743-5101
  • Fax: 208-746-5282
Mailing address:
  • Phone: 208-743-5101
  • Fax: 208-746-5282

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name: MR. MICHAEL PATRICK EMERY
Title or Position: OWNER
Credential:
Phone: 208-743-5101