Healthcare Provider Details

I. General information

NPI: 1235706847
Provider Name (Legal Business Name): SAWTOOTH WELLNESS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/10/2021
Last Update Date: 06/10/2021
Certification Date: 06/10/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1092 EASTLAND DR N
TWIN FALLS ID
83301-8442
US

IV. Provider business mailing address

PO BOX 5092
TWIN FALLS ID
83303-5092
US

V. Phone/Fax

Practice location:
  • Phone: 208-490-4648
  • Fax: 208-400-5310
Mailing address:
  • Phone: 208-490-4648
  • Fax: 208-400-5310

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code261QM0855X
TaxonomyAdolescent and Children Mental Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MR. OCTAVIO ARROYO SALDANA
Title or Position: OWNER/CLINICIAN
Credential: MSW, LCSW
Phone: 208-490-4648