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General NPI Number Information
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NPI Number | 1043946924
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Entity Type | Organization
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Legal Business Name | GEM PREP: MERIDIAN SOUTH LLC
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Dates
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Enumeration Date | 07/25/2022
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Last Update Date | 09/30/2025
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Provider Practice Location Address
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Address Line | 1925 E.LAKE HAZEL RD.
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City | MERIDIAN
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State | ID
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Zip | 83642-8382
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Country | US
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Telephone | 208-877-1513
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 86
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City | DEARY
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State | ID
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Zip | 83823-0086
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | DIRECTOR OF FINANCE
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Name | LORI BOGAR
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Credential |
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Telephone | 208-877-1513
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251300000X
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Taxonomy Name | Local Education Agency (LEA)
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License Number |
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License Number State |
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