Healthcare Provider Details

I. General information

NPI: 1083852982
Provider Name (Legal Business Name): EMBRACE WELLNESS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/30/2009
Last Update Date: 02/15/2024
Certification Date: 02/15/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1943 N LOCUST GROVE RD
MERIDIAN ID
83646
US

IV. Provider business mailing address

PO BOX 819
EAGLE ID
83616
US

V. Phone/Fax

Practice location:
  • Phone: 208-343-3883
  • Fax:
Mailing address:
  • Phone: 208-343-3883
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License NumberN-32864
License Number StateID

VIII. Authorized Official

Name: MRS. TAMMY L. HADFIELD
Title or Position: PRESIDENT-OWNER
Credential: N.P.
Phone: 208-287-8400