Provider Demographics
NPI:1578337622
Name:SOLACE PEDIATRIC HEALTHCARE THERAPY SERVICES IDAHO, LLC
Entity Type:Organization
Organization Name:SOLACE PEDIATRIC HEALTHCARE THERAPY SERVICES IDAHO, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:LINDSAY
Authorized Official - Middle Name:
Authorized Official - Last Name:MILLER
Authorized Official - Suffix:
Authorized Official - Credentials:CCC-SLP
Authorized Official - Phone:720-642-8343
Mailing Address - Street 1:4500 E CHERRY CREEK SOUTH DR STE 710
Mailing Address - Street 2:
Mailing Address - City:GLENDALE
Mailing Address - State:CO
Mailing Address - Zip Code:80246-1534
Mailing Address - Country:US
Mailing Address - Phone:303-432-8487
Mailing Address - Fax:
Practice Address - Street 1:950 W BANNOCK ST STE 1100
Practice Address - Street 2:
Practice Address - City:BOISE
Practice Address - State:ID
Practice Address - Zip Code:83702-6140
Practice Address - Country:US
Practice Address - Phone:986-213-4151
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-11-09
Last Update Date:2023-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health