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General NPI Number Information
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NPI Number | 1447557335
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Entity Type | Organization
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Legal Business Name | THE LILYPAD, LLC
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Dates
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Enumeration Date | 02/11/2011
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Last Update Date | 02/11/2011
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Provider Practice Location Address
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Address Line | 2010 W ROSTEN AVE
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City | NAMPA
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State | ID
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Zip | 83686-4854
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Country | US
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Telephone | 208-546-9723
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Fax | 866-308-7175
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Provider Business Mailing Address
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Address Line | PO BOX 1593
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City | NAMPA
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State | ID
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Zip | 83653-1593
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Country | US
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Telephone | 208-546-9723
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Fax | 866-308-7175
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Authorized Official
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Title or Position | PRESIDENT
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Name | MATTHEW S WARD
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Credential |
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Telephone | 208-546-9723
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251C00000X
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Taxonomy Name | Developmentally Disabled Services Day Training Agency
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License Number | DDA-1341
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License Number State | ID
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