Provider Demographics
NPI:1568887404
Name:SELKIRK OUTDOOR LEADERSHIP & EDUCATION (SOLE), INC
Entity Type:Organization
Organization Name:SELKIRK OUTDOOR LEADERSHIP & EDUCATION (SOLE), INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:D
Authorized Official - Last Name:WEBB
Authorized Official - Suffix:
Authorized Official - Credentials:MA
Authorized Official - Phone:208-946-6960
Mailing Address - Street 1:1255 MEADOWOOD RD
Mailing Address - Street 2:
Mailing Address - City:SANDPOINT
Mailing Address - State:ID
Mailing Address - Zip Code:83864-4950
Mailing Address - Country:US
Mailing Address - Phone:208-946-6960
Mailing Address - Fax:
Practice Address - Street 1:121 WISCONSIN AVE STE 101
Practice Address - Street 2:
Practice Address - City:WHITEFISH
Practice Address - State:MT
Practice Address - Zip Code:59937-2304
Practice Address - Country:US
Practice Address - Phone:928-351-7653
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-03-02
Last Update Date:2014-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT29320800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320800000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Mental Illness