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NPI Code Detail

MEDICARE: ADOLPHO ENTERPRISE LLC.

MEDICARE: ADOLPHO ENTERPRISE 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
1207Q00000XFamily Medicine Physician
2208D00000XGeneral Practice Physician
3101YM0800XMental Health Counselor
4103T00000XPsychologist
5103TC1900XCounseling Psychologist
6106H00000XMarriage & Family Therapist
7251S00000XCommunity/Behavioral Health Agency
8363A00000XPhysician Assistant
9363L00000XNurse Practitioner
10101Y00000XCounselor
11261QM0801XMental Health Clinic/Center (Including Community Mental Health Center)

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1932454642
Entity Type Code : Organization
Provider Name (Legal Business Name) : ADOLPHO ENTERPRISE LLC.
Provider Business Mailing Address
First Line : 3649 N LAKEHARBOR LN
Second Line :
City : BOISE
State : ID
Zip : 83703-6913
Country : US
Telephone Number : 435-553-9822
Fax Number : 208-853-5377
Provider Business Practice Location Address
First Line : 3649 N LAKEHARBOR LN
Second Line :
City : BOISE
State : ID
Zip : 83703-6913
Country : US
Telephone Number : 435-553-9822
Fax Number : 208-853-5377
Authorized Official
Title or Position : OWNER
Name : RICK ADOLPHO
Credential : BS, MBA, PSR
Telephone Number : 435-553-9822
Provider Enumeration Date : 07/18/2012
Last Update Date : 05/23/2024

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Directions to “ADOLPHO ENTERPRISE LLC. ” Practice Location

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