Provider Demographics
NPI:1548395155
Name:LEYLINE ADVOCATES, LLC
Entity Type:Organization
Organization Name:LEYLINE ADVOCATES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:BRADFORD
Authorized Official - Last Name:DANIELS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:208-344-9797
Mailing Address - Street 1:290 W BOBWHITE CT STE 300
Mailing Address - Street 2:
Mailing Address - City:BOISE
Mailing Address - State:ID
Mailing Address - Zip Code:83706-6653
Mailing Address - Country:US
Mailing Address - Phone:208-344-9797
Mailing Address - Fax:208-344-9898
Practice Address - Street 1:290 W BOBWHITE CT STE 300
Practice Address - Street 2:
Practice Address - City:BOISE
Practice Address - State:ID
Practice Address - Zip Code:83706-6653
Practice Address - Country:US
Practice Address - Phone:208-344-9797
Practice Address - Fax:208-344-9898
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-22
Last Update Date:2012-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ID807195700251B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management
Provider Identifiers
StateIdentifier IDID TypeIssuer
ID807195700Medicaid