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General NPI Number Information
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NPI Number | 1043427446
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Entity Type | Organization
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Legal Business Name | RBTD INC
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Dates
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Enumeration Date | 05/16/2007
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Last Update Date | 05/21/2008
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Provider Practice Location Address
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Address Line | 152 E MAIN ST # 106
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City | RIGBY
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State | ID
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Zip | 83442-1418
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Country | US
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Telephone | 208-522-8899
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Fax | 208-522-6596
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Provider Business Mailing Address
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Address Line | 152 E MAIN ST # 106
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City | RIGBY
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State | ID
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Zip | 83442-1418
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Country | US
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Telephone | 208-522-8899
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Fax | 208-522-6596
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | MR. BRUCE W HAMPTON
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Credential | LSW
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Telephone | 208-522-8899
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number |
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License Number State |
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