Provider Demographics
NPI:1558903328
Name:DARING IN IDAHO, LLC
Entity Type:Organization
Organization Name:DARING IN IDAHO, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DIANA
Authorized Official - Middle Name:
Authorized Official - Last Name:HAKES
Authorized Official - Suffix:
Authorized Official - Credentials:LCWS
Authorized Official - Phone:208-515-7552
Mailing Address - Street 1:413 N ALLUMBAUGH STREET
Mailing Address - Street 2:SUITE 102
Mailing Address - City:BOISE
Mailing Address - State:ID
Mailing Address - Zip Code:83704
Mailing Address - Country:US
Mailing Address - Phone:208-515-7552
Mailing Address - Fax:208-343-4458
Practice Address - Street 1:413 N ALLUMBAUGH STREET
Practice Address - Street 2:SUITE 102
Practice Address - City:BOISE
Practice Address - State:ID
Practice Address - Zip Code:83704
Practice Address - Country:US
Practice Address - Phone:208-515-7552
Practice Address - Fax:208-343-4458
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-10-14
Last Update Date:2020-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty