Provider Demographics
NPI:1497318422
Name:DG PSYCHIATRIC SERVICES LLC
Entity Type:Organization
Organization Name:DG PSYCHIATRIC SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DINO
Authorized Official - Middle Name:J
Authorized Official - Last Name:GIOLITTI
Authorized Official - Suffix:
Authorized Official - Credentials:ARNP
Authorized Official - Phone:208-413-9973
Mailing Address - Street 1:928 GRELLE AVE
Mailing Address - Street 2:
Mailing Address - City:LEWISTON
Mailing Address - State:ID
Mailing Address - Zip Code:83501-5202
Mailing Address - Country:US
Mailing Address - Phone:208-413-9973
Mailing Address - Fax:208-413-9976
Practice Address - Street 1:523 1/2 MAIN ST STE 7
Practice Address - Street 2:
Practice Address - City:LEWISTON
Practice Address - State:ID
Practice Address - Zip Code:83501-1870
Practice Address - Country:US
Practice Address - Phone:208-413-9973
Practice Address - Fax:208-413-9976
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-04-16
Last Update Date:2019-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty