Healthcare Provider Details

I. General information

NPI: 1558287003
Provider Name (Legal Business Name): BATHWORKS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/29/2026
Last Update Date: 07/08/2026
Certification Date: 07/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2970 N VILLERE LN
MERIDIAN ID
83646-6635
US

IV. Provider business mailing address

2970 N VILLERE LN
MERIDIAN ID
83646-6635
US

V. Phone/Fax

Practice location:
  • Phone: 208-869-9724
  • Fax:
Mailing address:
  • Phone: 208-869-9724
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171W00000X
TaxonomyContractor
License Number
License Number State

VIII. Authorized Official

Name: BRETT R STEVENS
Title or Position: OWNER
Credential:
Phone: 208-869-9724