Provider Demographics
NPI:1114406204
Name:GEM PREP: MERIDIAN LLC
Entity Type:Organization
Organization Name:GEM PREP: MERIDIAN LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FINANCE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:LORI
Authorized Official - Middle Name:A
Authorized Official - Last Name:BOGAR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:208-877-1513
Mailing Address - Street 1:PO BOX 86
Mailing Address - Street 2:
Mailing Address - City:DEARY
Mailing Address - State:ID
Mailing Address - Zip Code:83823-0086
Mailing Address - Country:US
Mailing Address - Phone:208-877-1513
Mailing Address - Fax:208-877-1713
Practice Address - Street 1:2750 E.GALA CT.
Practice Address - Street 2:
Practice Address - City:MERIDIAN
Practice Address - State:ID
Practice Address - Zip Code:83642
Practice Address - Country:US
Practice Address - Phone:208-877-1513
Practice Address - Fax:208-877-1713
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-08-09
Last Update Date:2020-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management