Provider Demographics
NPI:1346799483
Name:HEALING SANCTUARY LLC
Entity Type:Organization
Organization Name:HEALING SANCTUARY LLC
Other - Org Name:THE HEALING SANCTUARY LLC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:BILLING SUPERVISOR
Authorized Official - Prefix:
Authorized Official - First Name:BECKY
Authorized Official - Middle Name:
Authorized Official - Last Name:WATSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:208-497-0500
Mailing Address - Street 1:187 E 13TH ST
Mailing Address - Street 2:
Mailing Address - City:IDAHO FALLS
Mailing Address - State:ID
Mailing Address - Zip Code:83404-5305
Mailing Address - Country:US
Mailing Address - Phone:208-497-0500
Mailing Address - Fax:208-497-0505
Practice Address - Street 1:187 E 13TH ST
Practice Address - Street 2:
Practice Address - City:IDAHO FALLS
Practice Address - State:ID
Practice Address - Zip Code:83404-5305
Practice Address - Country:US
Practice Address - Phone:208-497-0500
Practice Address - Fax:208-497-0505
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-09-30
Last Update Date:2023-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
No261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty
No261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care