Provider Demographics
NPI:1689215162
Name:IRISEBYGETTE LLC
Entity Type:Organization
Organization Name:IRISEBYGETTE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PEER RECOVERY SPECIALIST
Authorized Official - Prefix:MS
Authorized Official - First Name:GEORGETTE
Authorized Official - Middle Name:F
Authorized Official - Last Name:DILWORTH
Authorized Official - Suffix:
Authorized Official - Credentials:PRS
Authorized Official - Phone:928-388-4551
Mailing Address - Street 1:13701 RIVER WALK PL APT 203
Mailing Address - Street 2:
Mailing Address - City:CHESTER
Mailing Address - State:VA
Mailing Address - Zip Code:23836-6166
Mailing Address - Country:US
Mailing Address - Phone:928-388-4551
Mailing Address - Fax:
Practice Address - Street 1:13701 RIVER WALK PL APT 203
Practice Address - Street 2:
Practice Address - City:CHESTER
Practice Address - State:VA
Practice Address - Zip Code:23836-6166
Practice Address - Country:US
Practice Address - Phone:928-388-4551
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-10-04
Last Update Date:2019-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes175T00000XOther Service ProvidersPeer SpecialistGroup - Multi-Specialty