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General NPI Number Information
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NPI Number | 1831410760
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Entity Type | Organization
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Legal Business Name | STILL WATERS, INCORPORATED
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Dates
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Enumeration Date | 06/15/2010
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Last Update Date | 06/15/2010
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Provider Practice Location Address
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Address Line | 4138 RENO DR
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City | POCATELLO
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State | ID
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Zip | 83202-5086
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Country | US
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Telephone | 208-221-2553
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Fax |
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Provider Business Mailing Address
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Address Line | 4138 RENO DR
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City | POCATELLO
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State | ID
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Zip | 83202-5086
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Country | US
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Telephone | 208-221-2553
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Fax |
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Authorized Official
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Title or Position | TREASURER
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Name | MRS. PATRICIA L SEILER
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Credential |
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Telephone | 208-221-2553
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM0850X
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Taxonomy Name | Adult Mental Health Clinic/Center
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License Number |
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License Number State |
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