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NPI Code Detail

MEDICARE: TANTA INC

MEDICARE: TANTA INC
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
11041C0700XClinical Social Worker
2251S00000XCommunity/Behavioral Health Agency

General Provider Information

NPI Number : 1871367276
Entity Type Code : Organization
Provider Name (Legal Business Name) : TANTA INC
Provider Business Mailing Address
First Line : 413 W IDAHO ST STE 302
Second Line :
City : BOISE
State : ID
Zip : 83702-6066
Country : US
Telephone Number : 208-333-8333
Fax Number : 208-344-7233
Provider Business Practice Location Address
First Line : 413 W IDAHO ST STE 302
Second Line :
City : BOISE
State : ID
Zip : 83702-6066
Country : US
Telephone Number : 208-333-8333
Fax Number : 208-344-7233
Authorized Official
Title or Position : EXECUTIVE DIRECTOR
Name : RAMATOULIE DEEN
Credential : LCSW
Telephone Number : 208-333-8333
Provider Enumeration Date : 11/07/2023
Last Update Date : 12/01/2025

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Directions to “TANTA INC ” Practice Location

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