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General NPI Number Information
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NPI Number | 1962301135
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Entity Type | Organization
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Legal Business Name | WELLHARBOR ID LLC
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Dates
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Enumeration Date | 11/04/2026
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Last Update Date | 11/04/2026
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Provider Practice Location Address
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Address Line | 999 W MAIN ST
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City | BOISE
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State | ID
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Zip | 83702-9000
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Country | US
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Telephone | 732-860-8460
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Fax |
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Provider Business Mailing Address
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Address Line | 999 W MAIN ST STE 100
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City | BOISE
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State | ID
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Zip | 83702-9001
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Country | US
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Telephone | 732-860-8460
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Fax |
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Authorized Official
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Title or Position | DIRECTOR
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Name | MARC SHEPARD
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Credential |
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Telephone | 732-860-8460
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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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