Provider Demographics
NPI:1851136600
Name:TETON SERVICE COORDINATION LLC
Entity type:Organization
Organization Name:TETON SERVICE COORDINATION LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:JODI
Authorized Official - Middle Name:
Authorized Official - Last Name:COPELAND
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:986-217-4584
Mailing Address - Street 1:1036 E IRON EAGLE DR STE 166
Mailing Address - Street 2:
Mailing Address - City:EAGLE
Mailing Address - State:ID
Mailing Address - Zip Code:83616-2413
Mailing Address - Country:US
Mailing Address - Phone:986-217-4584
Mailing Address - Fax:
Practice Address - Street 1:1036 E IRON EAGLE DR STE 166
Practice Address - Street 2:
Practice Address - City:EAGLE
Practice Address - State:ID
Practice Address - Zip Code:83616-2413
Practice Address - Country:US
Practice Address - Phone:986-217-4584
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-06-25
Last Update Date:2024-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management