MEDICARE: LEYLINE ADVOCATES, LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QM0801X	Mental Health Clinic/Center (Including Community Mental Health Center)

General Provider Information

NPI Number	:	1538436647
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LEYLINE ADVOCATES, LLC

Provider Business Mailing Address
First Line	:	290 W BOBWHITE CT STE 300
Second Line	:
City	:	BOISE
State	:	ID
Zip	:	83706-6653
Country	:	US
Telephone Number	:	208-344-9797
Fax Number	:

Provider Business Practice Location Address
First Line	:	250 W BOBWHITE CT STE 230
Second Line	:
City	:	BOISE
State	:	ID
Zip	:	83706-6656
Country	:	US
Telephone Number	:	208-344-9797
Fax Number	:

Authorized Official
Title or Position	:	MANAGER
Name	:	MR. JIM DANIELS
Credential	:
Telephone Number	:	208-344-9797

Provider Enumeration Date	:	11/18/2011
Last Update Date	:	04/27/2012

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