Provider Demographics
NPI:1598425027
Name:ADVOCATE WARRIORS LLC
Entity Type:Organization
Organization Name:ADVOCATE WARRIORS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MIKAYLA
Authorized Official - Middle Name:E
Authorized Official - Last Name:RIRIE
Authorized Official - Suffix:
Authorized Official - Credentials:MA
Authorized Official - Phone:208-421-6612
Mailing Address - Street 1:8918 W NORTHVIEW ST
Mailing Address - Street 2:
Mailing Address - City:BOISE
Mailing Address - State:ID
Mailing Address - Zip Code:83704-7017
Mailing Address - Country:US
Mailing Address - Phone:208-421-6612
Mailing Address - Fax:
Practice Address - Street 1:4696 W OVERLAND RD STE 182
Practice Address - Street 2:
Practice Address - City:BOISE
Practice Address - State:ID
Practice Address - Zip Code:83705-2878
Practice Address - Country:US
Practice Address - Phone:208-421-6612
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-12-24
Last Update Date:2023-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)Group - Single Specialty