=====================================================
General NPI Number Information
=====================================================
NPI Number | 1740329143
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | CREATING OPTIONS LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/05/2007
-----------------------------------------------------
Last Update Date | 08/22/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2390 AMERICAN LEGION BLVD SUITE 2
-----------------------------------------------------
City | MOUNTAIN HOME
-----------------------------------------------------
State | ID
-----------------------------------------------------
Zip | 83647-3109
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 208-587-8095
-----------------------------------------------------
Fax | 208-587-8025
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 1083
-----------------------------------------------------
City | MOUNTAIN HOME
-----------------------------------------------------
State | ID
-----------------------------------------------------
Zip | 83647-1083
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 208-587-8095
-----------------------------------------------------
Fax | 208-587-8025
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | AGENCY DIRECTOR
-----------------------------------------------------
Name | STEPHAN RILEY
-----------------------------------------------------
Credential | BA
-----------------------------------------------------
Telephone | 208-587-8095
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 251S00000X
-----------------------------------------------------
Taxonomy Name | Community/Behavioral Health Agency
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------