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General NPI Number Information
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NPI Number | 1962604942
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Entity Type | Organization
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Legal Business Name | REDDOOR REHABILITATION INC.
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Dates
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Enumeration Date | 06/03/2007
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Last Update Date | 12/31/2025
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Provider Practice Location Address
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Address Line | 1420 N HIGHWAY 33 STE 203
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City | DRIGGS
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State | ID
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Zip | 83422-5316
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Country | US
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Telephone | 208-354-3005
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Fax | 208-354-3006
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Provider Business Mailing Address
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Address Line | 1420 N HIGHWAY 33 STE 203
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City | DRIGGS
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State | ID
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Zip | 83422-5316
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Country | US
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Telephone | 208-354-3005
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Fax | 208-354-3006
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Authorized Official
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Title or Position | PRESIDENT
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Name | MRS. EVITA MARLENE HARRIS
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Credential | B.A.
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Telephone | 208-354-3005
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251B00000X
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Taxonomy Name | Case Management Agency
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License Number |
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License Number State | ID
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Taxonomy #2
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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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