Provider Demographics
NPI:1699017806
Name:ABOUT FACE MENTAL REHABILITATION
Entity Type:Organization
Organization Name:ABOUT FACE MENTAL REHABILITATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:DAYLE
Authorized Official - Last Name:KIRKENDALL
Authorized Official - Suffix:
Authorized Official - Credentials:MA, BS, AS
Authorized Official - Phone:208-412-3142
Mailing Address - Street 1:7421 E SAXTON LN
Mailing Address - Street 2:
Mailing Address - City:NAMPA
Mailing Address - State:ID
Mailing Address - Zip Code:83687-9483
Mailing Address - Country:US
Mailing Address - Phone:208-412-3142
Mailing Address - Fax:
Practice Address - Street 1:7421 E SAXTON LN
Practice Address - Street 2:
Practice Address - City:NAMPA
Practice Address - State:ID
Practice Address - Zip Code:83687-9483
Practice Address - Country:US
Practice Address - Phone:208-412-3142
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-03-26
Last Update Date:2013-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health