Provider Demographics
NPI:1811029341
Name:4 PILLARS OF SUCCESS LLC
Entity Type:Organization
Organization Name:4 PILLARS OF SUCCESS LLC
Other - Org Name:REHABILITATIVE HEALTH SERVICES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:BILLING DEPARTMENT DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:DEMI
Authorized Official - Middle Name:
Authorized Official - Last Name:ECHI-ABOLI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:208-360-1038
Mailing Address - Street 1:PO BOX 2106
Mailing Address - Street 2:
Mailing Address - City:IDAHO FALLS
Mailing Address - State:ID
Mailing Address - Zip Code:83403-2106
Mailing Address - Country:US
Mailing Address - Phone:208-522-8899
Mailing Address - Fax:208-522-6596
Practice Address - Street 1:1619 CURLEW DR STE 9
Practice Address - Street 2:
Practice Address - City:AMMON
Practice Address - State:ID
Practice Address - Zip Code:83406-4719
Practice Address - Country:US
Practice Address - Phone:208-497-0807
Practice Address - Fax:208-514-4055
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-11
Last Update Date:2022-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ID805208400Medicaid