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General NPI Number Information
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NPI Number | 1346061777
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Entity Type | Organization
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Legal Business Name | SAFE RELEASE HOUSE
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Dates
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Enumeration Date | 10/18/2024
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Last Update Date | 10/18/2024
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Provider Practice Location Address
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Address Line | 8154 W PACKSADDLE DR
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City | BOISE
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State | ID
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Zip | 83709-4964
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Country | US
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Telephone | 208-919-7610
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Fax |
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Provider Business Mailing Address
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Address Line | 8154 W PACKSADDLE DR
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City | BOISE
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State | ID
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Zip | 83709-4964
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Country | US
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Telephone | 208-919-7610
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | JENNY JEAN RICKS
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Credential |
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Telephone | 208-919-7610
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 276400000X
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Taxonomy Name | Substance Use Disorder Rehabilitation Hospital Unit
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License Number |
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License Number State |
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