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General NPI Number Information
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NPI Number | 1699017806
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Entity Type | Organization
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Legal Business Name | ABOUT FACE MENTAL REHABILITATION
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Dates
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Enumeration Date | 03/26/2013
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Last Update Date | 03/26/2013
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Provider Practice Location Address
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Address Line | 7421 E SAXTON LN
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City | NAMPA
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State | ID
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Zip | 83687-9483
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Country | US
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Telephone | 208-412-3142
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Fax |
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Provider Business Mailing Address
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Address Line | 7421 E SAXTON LN
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City | NAMPA
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State | ID
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Zip | 83687-9483
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Country | US
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Telephone | 208-412-3142
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | RICHARD DAYLE KIRKENDALL
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Credential | MA, BS, AS
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Telephone | 208-412-3142
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number |
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License Number State |
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