Provider Demographics
NPI:1194926790
Name:SNAKE RIVER REHABILITATION COUNSELING SERVICES,LLC
Entity type:Organization
Organization Name:SNAKE RIVER REHABILITATION COUNSELING SERVICES,LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MICHELLE
Authorized Official - Middle Name:
Authorized Official - Last Name:FITTING
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:208-743-5101
Mailing Address - Street 1:1630 23RD AVE
Mailing Address - Street 2:# 301B
Mailing Address - City:LEWISTON
Mailing Address - State:ID
Mailing Address - Zip Code:83501-6350
Mailing Address - Country:US
Mailing Address - Phone:208-743-5101
Mailing Address - Fax:208-746-5282
Practice Address - Street 1:1630 23RD AVE
Practice Address - Street 2:# 301B
Practice Address - City:LEWISTON
Practice Address - State:ID
Practice Address - Zip Code:83501-6350
Practice Address - Country:US
Practice Address - Phone:208-743-5101
Practice Address - Fax:208-746-5282
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-30
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251C00000XAgenciesDay Training, Developmentally Disabled Services