| Eagle Crest Life Services Inc | |
|
212 S 11th St Ste 3 Coeur D Alene ID 83814-4000 | |
| (208) 666-9162 | |
| Not Available |
| Full Name | Eagle Crest Life Services Inc |
|---|---|
| Speciality | Psychiatry & Neurology - Psychiatry |
| Location | 212 S 11th St Ste 3, Coeur D Alene, Idaho |
| Authorized Official Name and Position | Robert K Wheeler (OWNER) |
| Authorized Official Contact | 2086669162 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Eagle Crest Life Services Inc Po Box 3723 Coeur D Alene ID 83816-2529 Ph: (208) 666-9162 | Eagle Crest Life Services Inc 212 S 11th St Ste 3 Coeur D Alene ID 83814-4000 Ph: (208) 666-9162 |
| NPI Number | 1356500649 |
|---|---|
| Provider Enumeration Date | 06/03/2008 |
| Last Update Date | 02/20/2009 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1356500649 | NPI | - | NPPES |
| 807336200 | Medicaid | ID |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 2084P0800X | Psychiatry & Neurology - Psychiatry | (* (Not Available)) | Primary |
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