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General NPI Number Information
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NPI Number | 1467142315
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Entity Type | Organization
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Legal Business Name | LIFEHOUSE HEALTHCARE PLLC
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Dates
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Enumeration Date | 05/12/2023
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Last Update Date | 11/01/2023
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Provider Practice Location Address
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Address Line | 212 S 11TH ST STE 1
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City | COEUR D ALENE
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State | ID
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Zip | 83814-4000
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Country | US
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Telephone | 208-243-9395
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Fax | 951-466-2426
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Provider Business Mailing Address
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Address Line | 212 S 11TH ST STE 1
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City | COEUR D ALENE
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State | ID
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Zip | 83814-4000
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Country | US
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Telephone | 208-667-3113
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Fax | 208-668-8213
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Authorized Official
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Title or Position | SOLE MEMBER
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Name | MR. CARLO R OROZCO
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Credential | NP
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Telephone | 208-243-9395
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM1300X
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Taxonomy Name | Multi-Specialty Clinic/Center
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License Number |
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License Number State |
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