Provider Demographics
NPI:1043426414
Name:WEAVER LLC
Entity Type:Organization
Organization Name:WEAVER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:MS
Authorized Official - First Name:KAREN
Authorized Official - Middle Name:M
Authorized Official - Last Name:MARTINAT
Authorized Official - Suffix:
Authorized Official - Credentials:LMSW
Authorized Official - Phone:208-731-3789
Mailing Address - Street 1:1611 MAPLE AVE
Mailing Address - Street 2:
Mailing Address - City:TWIN FALLS
Mailing Address - State:ID
Mailing Address - Zip Code:83301-6644
Mailing Address - Country:US
Mailing Address - Phone:208-731-3789
Mailing Address - Fax:
Practice Address - Street 1:1611 MAPLE AVE
Practice Address - Street 2:
Practice Address - City:TWIN FALLS
Practice Address - State:ID
Practice Address - Zip Code:83301-6644
Practice Address - Country:US
Practice Address - Phone:208-731-3789
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-15
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management
Provider Identifiers
StateIdentifier IDID TypeIssuer
ID8055125Medicaid