Provider Demographics
NPI:1043427446
Name:RBTD INC
Entity Type:Organization
Organization Name:RBTD INC
Other - Org Name:IMPACT
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:BRUCE
Authorized Official - Middle Name:W
Authorized Official - Last Name:HAMPTON
Authorized Official - Suffix:
Authorized Official - Credentials:LSW
Authorized Official - Phone:208-522-8899
Mailing Address - Street 1:152 E MAIN ST # 106
Mailing Address - Street 2:
Mailing Address - City:RIGBY
Mailing Address - State:ID
Mailing Address - Zip Code:83442-1418
Mailing Address - Country:US
Mailing Address - Phone:208-522-8899
Mailing Address - Fax:208-522-6596
Practice Address - Street 1:152 E MAIN ST # 106
Practice Address - Street 2:
Practice Address - City:RIGBY
Practice Address - State:ID
Practice Address - Zip Code:83442-1418
Practice Address - Country:US
Practice Address - Phone:208-522-8899
Practice Address - Fax:208-522-6596
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-16
Last Update Date:2008-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
ID=========OtherTAX ID