Provider Demographics
NPI:1003928961
Name:MARINELL RHINE SOLUTIONS FOR LIFE
Entity Type:Organization
Organization Name:MARINELL RHINE SOLUTIONS FOR LIFE
Other - Org Name:SOLUTIONS FOR LIFE
Other - Org Type:Other Name
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:MARINELL
Authorized Official - Middle Name:STEVENSON
Authorized Official - Last Name:RHINE
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:208-226-7500
Mailing Address - Street 1:239 IDAHO ST
Mailing Address - Street 2:
Mailing Address - City:AMERICAN FALLS
Mailing Address - State:ID
Mailing Address - Zip Code:83211-1235
Mailing Address - Country:US
Mailing Address - Phone:208-226-7500
Mailing Address - Fax:208-226-7501
Practice Address - Street 1:239 IDAHO ST
Practice Address - Street 2:
Practice Address - City:AMERICAN FALLS
Practice Address - State:ID
Practice Address - Zip Code:83211-1235
Practice Address - Country:US
Practice Address - Phone:208-226-7500
Practice Address - Fax:208-226-7501
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-31
Last Update Date:2008-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDLSW-23983101YA0400X
IDLCSW-822101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Multi-Specialty
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IDL3761OtherBLUE CROSS
ID806983300Medicaid
IDL6104OtherBLUE CROSS OF IDAHO
ID806966600Medicaid
ID8N468OtherBLUE CROSS OF IDAHO
ID000010148188OtherBLUE SHIELD
ID806983300Medicaid