Provider Demographics
NPI:1568669257
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:RENE
Authorized Official - Last Name:FITTING
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:208-743-5101
Mailing Address - Street 1:1630 23RD AVE STE 301B
Mailing Address - Street 2:
Mailing Address - City:LEWISTON
Mailing Address - State:ID
Mailing Address - Zip Code:83501-6357
Mailing Address - Country:US
Mailing Address - Phone:208-743-5101
Mailing Address - Fax:
Practice Address - Street 1:1630 23RD AVE STE 301B
Practice Address - Street 2:
Practice Address - City:LEWISTON
Practice Address - State:ID
Practice Address - Zip Code:83501-6357
Practice Address - Country:US
Practice Address - Phone:208-743-5101
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-27
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management