Provider Demographics
NPI:1235562604
Name:HEALTHY RESOLUTIONS, PLLC
Entity Type:Organization
Organization Name:HEALTHY RESOLUTIONS, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:AGENCY DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:CONNIE
Authorized Official - Middle Name:C
Authorized Official - Last Name:HAHN
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:208-786-7040
Mailing Address - Street 1:135 MCKINLEY AVE
Mailing Address - Street 2:
Mailing Address - City:KELLOGG
Mailing Address - State:ID
Mailing Address - Zip Code:83837-2567
Mailing Address - Country:US
Mailing Address - Phone:208-786-7040
Mailing Address - Fax:208-682-9952
Practice Address - Street 1:135 MCKINLEY AVE
Practice Address - Street 2:
Practice Address - City:KELLOGG
Practice Address - State:ID
Practice Address - Zip Code:83837-2567
Practice Address - Country:US
Practice Address - Phone:208-786-7040
Practice Address - Fax:208-682-9952
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-08-20
Last Update Date:2013-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ID0-246261QH0100X
ID26450261QM0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service
No261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
Provider Identifiers
StateIdentifier IDID TypeIssuer
ID19225121086Medicaid