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General NPI Number Information
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NPI Number | 1336797042
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Entity Type | Organization
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Legal Business Name | BRIGHTVIEW SENIOR HEALTH
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Dates
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Enumeration Date | 08/27/2019
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Last Update Date | 09/09/2019
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Provider Practice Location Address
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Address Line | 1983 N SYNERGY PL
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City | EAGLE
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State | ID
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Zip | 83616-7332
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Country | US
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Telephone | 208-509-8987
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Fax | 208-225-6858
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Provider Business Mailing Address
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Address Line | 141 N PALMETTO AVE UNIT 602
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City | EAGLE
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State | ID
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Zip | 83616-8025
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Country | US
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Telephone | 208-509-8987
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Fax | 208-225-6858
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Authorized Official
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Title or Position | DO, OWNER
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Name | LOUISE YE-LIEW
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Credential | DO
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Telephone | 208-509-8987
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208D00000X
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Taxonomy Name | General Practice Physician
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License Number |
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License Number State |
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