Provider Demographics
NPI:1376280156
Name:GREVER, SARAH E (NA)
Entity Type:Individual
Prefix:MISS
First Name:SARAH
Middle Name:E
Last Name:GREVER
Suffix:
Gender:F
Credentials:NA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:25300 KINGSBURY RD
Mailing Address - Street 2:
Mailing Address - City:MIDDLETON
Mailing Address - State:ID
Mailing Address - Zip Code:83644-5351
Mailing Address - Country:US
Mailing Address - Phone:208-869-3740
Mailing Address - Fax:
Practice Address - Street 1:25300 KINGSBURY RD
Practice Address - Street 2:
Practice Address - City:MIDDLETON
Practice Address - State:ID
Practice Address - Zip Code:83644-5351
Practice Address - Country:US
Practice Address - Phone:208-869-3740
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-05-13
Last Update Date:2022-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes385HR2060XRespite Care FacilityRespite CareRespite Care, Intellectual and/or Developmental Disabilities, Child
Provider Identifiers
StateIdentifier IDID TypeIssuer
IDZG400026EOtherSTATE OF IDAHO