Innercept

NPI 1003086653 - Community Based Residential Treatment Facility, Mental Illness - 320800000X

NPI Details
NPI 1003086653
Enumeration Date 03/10/2008
Last Updated 03/10/2008
Entity Type Healthcare Provider
Active Over 10 years ago
Authorized Information
Name GEORGE JACKSON GEORGE
Position MEDICAL DIRECTOR
Phone (208) 665-7178
Fax (208) 765-6972
Practice Location
1115 IRONWOOD DR
SUITE A
COEUR D ALENE ID, 83814-4936, US
Phone (208) 665-7178
Fax (208) 765-6972
Business Location
PO BOX 1356
COEUR D ALENE ID, 83816, US
Phone (208) 665-7178
Fax (208) 765-6972
Toxanomy
Taxonomy Code 320800000X
License State
License Number
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According to our database, Innercept NPI is 1003086653, taxonomy code is 320800000X Innercept physically located at 1115 Ironwood Dr, Coeur D Alene ID, 83814-4936. NPI Number 1033115704 has the healthcare provider type.

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1003086653 NPI number is provided on an as is basis without warranty of any kind. 1003086653 is maintained by the National Plan & Provider Enumeration System. The contents of Innercept are for informational purposes only.