| Daring In Idaho, Llc | |
|
413 N Allumbaugh Street Suite 102 Boise ID 83704 | |
| (208) 515-7552 | |
| (208) 343-4458 |
| Full Name | Daring In Idaho, Llc |
|---|---|
| Speciality | Social Worker |
| Location | 413 N Allumbaugh Street, Boise, Idaho |
| Authorized Official Name and Position | Diana Hakes (OWNER) |
| Authorized Official Contact | 2085157552 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Daring In Idaho, Llc 413 N Allumbaugh Street Suite 102 Boise ID 83704 Ph: (208) 515-7552 | Daring In Idaho, Llc 413 N Allumbaugh Street Suite 102 Boise ID 83704 Ph: (208) 515-7552 |
| NPI Number | 1558903328 |
|---|---|
| Provider Enumeration Date | 10/14/2019 |
| Last Update Date | 02/14/2020 |
| Certification Date | 02/14/2020 |
| Medicare PECOS PAC ID | 6709210008 |
|---|---|
| Medicare Enrollment ID | O20191219000836 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1558903328 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1041C0700X | Social Worker - Clinical | (* (Not Available)) | Primary |
| Provider Name | Diane T Hakes |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1962821249 PECOS PAC ID: 7012235674 Enrollment ID: I20150410000037 |
| Provider Name | Ashley Brown |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1053826701 PECOS PAC ID: 8729419346 Enrollment ID: I20200515001157 |
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