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General NPI Number Information
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NPI Number | 1043161714
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Entity Type | Organization
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Legal Business Name | GEM STATE MOBILITY
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Dates
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Enumeration Date | 02/07/2026
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Last Update Date | 02/07/2026
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Provider Practice Location Address
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Address Line | 15242 HANKS WAY
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City | CALDWELL
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State | ID
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Zip | 83607-5485
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Country | US
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Telephone | 208-806-4997
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Fax |
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Provider Business Mailing Address
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Address Line | 1846 1ST ST STE 150
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City | IDAHO FALLS
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State | ID
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Zip | 83401-4415
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Country | US
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Telephone | 208-806-4997
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | MAKABELE T MWEMBO
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Credential |
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Telephone | 208-519-7545
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 372600000X
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Taxonomy Name | Adult Companion
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License Number |
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License Number State |
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