| Cultivation, Llc | |
|
211 Coeur D'alene Ave Ste 102 Coeur D'alene ID 83814 | |
| (208) 640-0861 | |
| Not Available |
| Full Name | Cultivation, Llc |
|---|---|
| Speciality | Community/behavioral Health |
| Location | 211 Coeur D'alene Ave Ste 102, Coeur D'alene, Idaho |
| Authorized Official Name and Position | Dan Hanks (OWNER) |
| Authorized Official Contact | 2086996817 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Cultivation, Llc 211 Coeur D'alene Ave Ste 102 Coeur D'alene ID 83814 Ph: (208) 640-0861 | Cultivation, Llc 211 Coeur D'alene Ave Ste 102 Coeur D'alene ID 83814 Ph: (208) 640-0861 |
| NPI Number | 1124466990 |
|---|---|
| Provider Enumeration Date | 06/13/2013 |
| Last Update Date | 06/13/2013 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1124466990 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 251S00000X | Community/behavioral Health | (* (Not Available)) | Primary |