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General NPI Number Information
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NPI Number | 1316734296
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Entity Type | Organization
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Legal Business Name | COPACETIC SUPPORTED LIVING
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Dates
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Enumeration Date | 04/23/2025
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Last Update Date | 04/23/2025
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Provider Practice Location Address
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Address Line | 540 S 16TH ST STE 112
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City | PAYETTE
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State | ID
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Zip | 83661-3514
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Country | US
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Telephone | 208-297-0811
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Fax |
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Provider Business Mailing Address
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Address Line | 540 S 16TH ST STE 112
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City | PAYETTE
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State | ID
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Zip | 83661-3514
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Country | US
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Telephone | 208-297-0811
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Fax |
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Authorized Official
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Title or Position | OWNER/OPERATOR
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Name | RILEY CASTILLO
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Credential |
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Telephone | 208-297-0811
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 253Z00000X
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Taxonomy Name | In Home Supportive Care Agency
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License Number |
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License Number State |
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