Provider Demographics
NPI:1073805099
Name:ASSURELINK, LLC
Entity Type:Organization
Organization Name:ASSURELINK, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:
Authorized Official - First Name:STEVE
Authorized Official - Middle Name:
Authorized Official - Last Name:HANSEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:208-523-2704
Mailing Address - Street 1:841 OXFORD DR
Mailing Address - Street 2:
Mailing Address - City:IDAHO FALLS
Mailing Address - State:ID
Mailing Address - Zip Code:83401-4204
Mailing Address - Country:US
Mailing Address - Phone:208-523-2704
Mailing Address - Fax:208-522-2603
Practice Address - Street 1:841 OXFORD DR
Practice Address - Street 2:
Practice Address - City:IDAHO FALLS
Practice Address - State:ID
Practice Address - Zip Code:83401-4204
Practice Address - Country:US
Practice Address - Phone:208-523-2704
Practice Address - Fax:208-522-2603
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-05-10
Last Update Date:2011-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management
Provider Identifiers
StateIdentifier IDID TypeIssuer
IDM8065523Medicaid