| Avanzar Wellness Llc | |
|
11513 W Fairview Ave Ste 105 Boise ID 83713-7887 | |
| (208) 908-7882 | |
| (208) 908-7883 |
| Full Name | Avanzar Wellness Llc |
|---|---|
| Speciality | Clinic/Center |
| Location | 11513 W Fairview Ave Ste 105, Boise, Idaho |
| Authorized Official Name and Position | Jose Carbajal (DIRECTOR OF OPERATIONS) |
| Authorized Official Contact | 2089087882 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Avanzar Wellness Llc 11513 W Fairview Ave Ste 105 Boise ID 83713-7887 Ph: (208) 908-7882 | Avanzar Wellness Llc 11513 W Fairview Ave Ste 105 Boise ID 83713-7887 Ph: (208) 908-7882 |
| NPI Number | 1871126797 |
|---|---|
| Provider Enumeration Date | 02/19/2020 |
| Last Update Date | 03/26/2020 |
| Certification Date | 03/26/2020 |
| Medicare PECOS PAC ID | 1557790854 |
|---|---|
| Medicare Enrollment ID | O20200408001775 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1871126797 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QM0801X | Clinic/center - Mental Health (including Community Mental Health Center) | (* (Not Available)) | Primary |
| Provider Name | Beatrice S Carroll |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1881730133 PECOS PAC ID: 1355524414 Enrollment ID: I20110328000087 |
| Provider Name | Kara Marie Kreizenbeck |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1821352378 PECOS PAC ID: 4082843743 Enrollment ID: I20140130000071 |
| Provider Name | Erik Gerald Roth |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1578803284 PECOS PAC ID: 4880063486 Enrollment ID: I20221202001483 |
| Provider Name | Ann Marie Walker |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1346707965 PECOS PAC ID: 3870965601 Enrollment ID: I20230203002657 |
| Provider Name | Ann Marie Clayton |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1184277618 PECOS PAC ID: 8325417421 Enrollment ID: I20240224000566 |
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