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General NPI Number Information
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NPI Number | 1942082730
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Entity Type | Organization
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Legal Business Name | BALANCED IDAHO LLC
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Dates
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Enumeration Date | 10/17/2023
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Last Update Date | 10/17/2023
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Provider Practice Location Address
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Address Line | 2176 E FRANKLIN RD STE 100
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City | MERIDIAN
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State | ID
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Zip | 83642-8009
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Country | US
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Telephone | 208-789-3625
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Fax | 866-435-6256
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Provider Business Mailing Address
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Address Line | 2176 E FRANKLIN RD STE 100
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City | MERIDIAN
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State | ID
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Zip | 83642-8009
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Country | US
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Telephone | 208-789-3625
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | JENNIFER LYNN MCINTYRE
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Credential | FNP
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Telephone | 951-970-5773
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM1300X
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Taxonomy Name | Multi-Specialty Clinic/Center
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License Number |
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License Number State |
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