| Cultivation, Llc | |
|
211 E. Coeur Dalene Ave. Ste 102 Coeur D'alene ID 83814 | |
| (208) 699-6817 | |
| (208) 620-2306 |
| Full Name | Cultivation, Llc |
|---|---|
| Speciality | Counselor - Professional |
| Location | 211 E. Coeur Dalene Ave. Ste 102, Coeur D'alene, Idaho |
| Authorized Official Name and Position | Karly Ireland (OFFICE MANAGER/ADMIN SUPERVISOR) |
| Authorized Official Contact | 2086996817 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Cultivation, Llc 211 E. Coeur Dalene Ave. Ste 102 Coeur D'alene ID 83814 Ph: (208) 699-6817 | Cultivation, Llc 211 E. Coeur Dalene Ave. Ste 102 Coeur D'alene ID 83814 Ph: (208) 699-6817 |
| NPI Number | 1295353217 |
|---|---|
| Provider Enumeration Date | 07/07/2020 |
| Last Update Date | 07/07/2020 |
| Certification Date | 07/07/2020 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1295353217 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 101YP2500X | Counselor - Professional | (* (Not Available)) | Primary |