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General NPI Number Information
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NPI Number | 1407283690
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Entity Type | Organization
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Legal Business Name | SUFFICIENCY ADVOCATE, LLC
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Dates
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Enumeration Date | 10/02/2013
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Last Update Date | 10/02/2013
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Provider Practice Location Address
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Address Line | 235 N 3RD E
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City | MOUNTAIN HOME
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State | ID
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Zip | 83647-2734
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Country | US
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Telephone | 208-587-2900
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Fax | 208-587-2992
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Provider Business Mailing Address
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Address Line | PO BOX 513
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City | MOUNTAIN HOME
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State | ID
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Zip | 83647-0513
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Country | US
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Telephone | 208-587-2900
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Fax | 208-587-2992
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Authorized Official
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Title or Position | OWNER
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Name | MR. WILLIAM MICHAEL LAWRENCE
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Credential |
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Telephone | 208-587-2900
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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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