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General NPI Number Information
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NPI Number | 1679909469
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Entity Type | Organization
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Legal Business Name | ADVANCED CARE NORTHWEST LLC
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Dates
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Enumeration Date | 09/24/2013
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Last Update Date | 12/31/2013
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Provider Practice Location Address
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Address Line | 1009 HIGHWAY 2 SUITE E
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City | SANDPOINT
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State | ID
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Zip | 83864-2712
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Country | US
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Telephone | 208-263-3225
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Fax | 208-946-2942
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Provider Business Mailing Address
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Address Line | PO BOX 1869
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City | BONNERS FERRY
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State | ID
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Zip | 83805-1869
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Country | US
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Telephone | 208-263-3225
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Fax | 208-946-2942
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Authorized Official
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Title or Position | MEMBER/MANAGER
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Name | AMY NICOLE BALDWIN
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Credential |
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Telephone | 208-610-3318
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 347C00000X
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Taxonomy Name | Private Vehicle
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License Number |
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License Number State |
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