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General NPI Number Information
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NPI Number | 1497318422
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Entity Type | Organization
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Legal Business Name | DG PSYCHIATRIC SERVICES LLC
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Dates
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Enumeration Date | 04/16/2019
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Last Update Date | 04/16/2019
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Provider Practice Location Address
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Address Line | 523 1/2 MAIN ST STE 7
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City | LEWISTON
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State | ID
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Zip | 83501-1870
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Country | US
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Telephone | 208-413-9973
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Fax | 208-413-9976
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Provider Business Mailing Address
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Address Line | 928 GRELLE AVE
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City | LEWISTON
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State | ID
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Zip | 83501-5202
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Country | US
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Telephone | 208-413-9973
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Fax | 208-413-9976
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Authorized Official
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Title or Position | OWNER
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Name | DINO J GIOLITTI
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Credential | ARNP
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Telephone | 208-413-9973
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number |
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License Number State |
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