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General NPI Number Information
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NPI Number | 1558029322
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Entity Type | Organization
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Legal Business Name | DAISY HOPE BEHAVIORAL SERVICES LLC
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Dates
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Enumeration Date | 11/29/2021
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Last Update Date | 11/29/2021
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Provider Practice Location Address
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Address Line | 3254 N 10TH ST
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City | COEUR D ALENE
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State | ID
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Zip | 83815-5060
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Country | US
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Telephone | 208-242-8839
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 179
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City | COEUR D ALENE
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State | ID
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Zip | 83816-0179
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Country | US
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Telephone | 208-242-8839
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Fax |
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Authorized Official
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Title or Position | AGENCY DIRECTOR
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Name | KIMBERLY COPPA
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Credential | BCBA
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Telephone | 208-242-8839
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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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