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General NPI Number Information
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NPI Number | 1912896259
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Entity Type | Organization
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Legal Business Name | SANCTUARY OF INTEGRATIVE WELLBEING
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Dates
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Enumeration Date | 07/01/2025
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Last Update Date | 09/05/2025
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Provider Practice Location Address
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Address Line | 30410 ID-200 SUITE 100
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City | PONDERAY
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State | ID
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Zip | 83852-9296
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Country | US
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Telephone | 715-790-0823
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Fax |
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Provider Business Mailing Address
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Address Line | 207 SKY MEADOW RD
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City | SAGLE
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State | ID
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Zip | 83860-9296
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Country | US
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Telephone | 715-790-0823
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | JOHN DIONA
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Credential |
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Telephone | 715-790-0823
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number |
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License Number State |
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