Provider Demographics
NPI:1164899951
Name:LIFEPATH SUPPORTS INC
Entity Type:Organization
Organization Name:LIFEPATH SUPPORTS INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PAYEE PROVIDER
Authorized Official - Prefix:
Authorized Official - First Name:TIFFANEY
Authorized Official - Middle Name:
Authorized Official - Last Name:GILES
Authorized Official - Suffix:
Authorized Official - Credentials:BA
Authorized Official - Phone:208-780-3900
Mailing Address - Street 1:10112 W OVERLAND RD
Mailing Address - Street 2:
Mailing Address - City:BOISE
Mailing Address - State:ID
Mailing Address - Zip Code:83709-1428
Mailing Address - Country:US
Mailing Address - Phone:208-780-3900
Mailing Address - Fax:
Practice Address - Street 1:10112 W OVERLAND RD
Practice Address - Street 2:
Practice Address - City:BOISE
Practice Address - State:ID
Practice Address - Zip Code:83709-1428
Practice Address - Country:US
Practice Address - Phone:208-780-3902
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-08-27
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center