Provider Demographics
NPI:1417720582
Name:A BIT OF LOVE
Entity Type:Organization
Organization Name:A BIT OF LOVE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PART OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:RYAN
Authorized Official - Middle Name:DEE
Authorized Official - Last Name:LAIRD
Authorized Official - Suffix:
Authorized Official - Credentials:MBA
Authorized Official - Phone:208-716-3659
Mailing Address - Street 1:3751 REDWOOD CT
Mailing Address - Street 2:
Mailing Address - City:REXBURG
Mailing Address - State:ID
Mailing Address - Zip Code:83440-4771
Mailing Address - Country:US
Mailing Address - Phone:208-716-3659
Mailing Address - Fax:
Practice Address - Street 1:2477 ROBISON DR
Practice Address - Street 2:
Practice Address - City:REXBURG
Practice Address - State:ID
Practice Address - Zip Code:83440-3307
Practice Address - Country:US
Practice Address - Phone:208-716-3659
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-11-01
Last Update Date:2023-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Multi-Specialty