Healthcare Provider Details

I. General information

NPI: 1750927372
Provider Name (Legal Business Name): RESTORING HOPE HEALING FROM TRAUMA AND ADDICTION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/19/2019
Last Update Date: 07/07/2026
Certification Date: 07/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2450 E GALA ST STE 120
MERIDIAN ID
83642-4805
US

IV. Provider business mailing address

PO BOX 1662
MERIDIAN ID
83680-1662
US

V. Phone/Fax

Practice location:
  • Phone: 208-315-6717
  • Fax: 208-315-6718
Mailing address:
  • Phone: 208-571-8459
  • Fax: 208-315-6718

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DENISE LEREIGH WHITEMAN
Title or Position: FINANCIAL DIRECTOR
Credential: MBA
Phone: 208-571-8459