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General NPI Number Information
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NPI Number | 1598481186
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Entity Type | Organization
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Legal Business Name | BRIARWOOD SAFE HOUSE LLC
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Dates
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Enumeration Date | 10/14/2022
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Last Update Date | 10/14/2022
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Provider Practice Location Address
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Address Line | 3685 W N YELLOWSTONE HWY
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City | REXBURG
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State | ID
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Zip | 83440
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Country | US
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Telephone | 208-573-6999
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Fax |
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Provider Business Mailing Address
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Address Line | 3685 W N YELLOWSTONE HWY
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City | REXBURG
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State | ID
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Zip | 83440
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Country | US
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Telephone | 208-573-6999
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Fax |
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Authorized Official
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Title or Position | MEMBER
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Name | STEVEN KILLION
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Credential |
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Telephone | 208-573-6999
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QR0405X
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Taxonomy Name | Substance Use Disorder Rehabilitation Clinic/Center
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 311ZA0620X
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Taxonomy Name | Adult Care Home Facility
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License Number |
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License Number State |
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