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General NPI Number Information
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NPI Number | 1437048758
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Entity Type | Organization
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Legal Business Name | SOAR SUPPORTED LIVING
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Dates
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Enumeration Date | 07/01/2025
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Last Update Date | 07/01/2025
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Provider Practice Location Address
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Address Line | 271 N. AVE. D
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City | KUNA
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State | ID
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Zip | 83634
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Country | US
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Telephone | 986-282-0029
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Fax |
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Provider Business Mailing Address
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Address Line | 2528 N HICKORY WAY
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City | MERIDIAN
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State | ID
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Zip | 83646-8077
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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 | OPERATOR/DIRECTOR
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Name | DAVID TOMASELLI
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Credential |
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Telephone | 986-282-0029
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 252Y00000X
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Taxonomy Name | Early Intervention Provider Agency
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License Number |
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License Number State |
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