Basic Information
| Provider Information | |||||||||
| NPI: | 1750927372 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | RESTORING HOPE HEALING FROM TRAUMA AND ADDICTION LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 1662 | ||||||||
| Address2: | |||||||||
| City: | MERIDIAN | ||||||||
| State: | ID | ||||||||
| PostalCode: | 836801662 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2085718459 | ||||||||
| FaxNumber: | 2083156718 | ||||||||
| Practice Location | |||||||||
| Address1: | 850 E FRANKLIN RD STE 405 | ||||||||
| Address2: | |||||||||
| City: | MERIDIAN | ||||||||
| State: | ID | ||||||||
| PostalCode: | 836428917 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2086029296 | ||||||||
| FaxNumber: | 2083434993 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/19/2019 | ||||||||
| LastUpdateDate: | 10/01/2020 | ||||||||
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| AuthorizedOfficialLastName: | WHITEMAN | ||||||||
| AuthorizedOfficialFirstName: | DENISE | ||||||||
| AuthorizedOfficialMiddleName: | LEREIGH | ||||||||
| AuthorizedOfficialTitleorPosition: | ADMINISTRATIVE DIRECTOR | ||||||||
| AuthorizedOfficialTelephone: | 2085718459 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | MBA | ||||||||
| NPICertificationDate: | 10/01/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YM0800X | N | 193200000X MULTI-SPECIALTY GROUP | Behavioral Health & Social Service Providers | Counselor | Mental Health | 251S00000X | N | Agencies | Community/Behavioral Health | 261QM0850X | Y | Ambulatory Health Care Facilities | Clinic/Center | Adult Mental Health |
No ID Information.