Provider Demographics
NPI:1326851098
Name:BLUE BIRD DAY PNW LLC
Entity type:Organization
Organization Name:BLUE BIRD DAY PNW LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL ADMINISTRATION
Authorized Official - Prefix:
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:
Authorized Official - Last Name:MAYBERRY
Authorized Official - Suffix:
Authorized Official - Credentials:LMSW
Authorized Official - Phone:208-659-2049
Mailing Address - Street 1:820 N. WILLIAM ST.
Mailing Address - Street 2:
Mailing Address - City:POST FALLS
Mailing Address - State:ID
Mailing Address - Zip Code:83854-8657
Mailing Address - Country:US
Mailing Address - Phone:208-818-5016
Mailing Address - Fax:
Practice Address - Street 1:820 N. WILLIAM ST.
Practice Address - Street 2:
Practice Address - City:POST FALLS
Practice Address - State:ID
Practice Address - Zip Code:83854-8657
Practice Address - Country:US
Practice Address - Phone:208-818-5016
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-01-28
Last Update Date:2025-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Single Specialty