Provider Demographics
NPI:1821337205
Name:CNC, INC.
Entity Type:Organization
Organization Name:CNC, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:G
Authorized Official - Last Name:RIDDLE
Authorized Official - Suffix:II
Authorized Official - Credentials:PT, DPT
Authorized Official - Phone:208-895-0022
Mailing Address - Street 1:3140 W MILANO DR
Mailing Address - Street 2:SUITE 100
Mailing Address - City:MERIDIAN
Mailing Address - State:ID
Mailing Address - Zip Code:83646-7290
Mailing Address - Country:US
Mailing Address - Phone:208-895-0022
Mailing Address - Fax:208-898-9308
Practice Address - Street 1:3140 W MILANO DR
Practice Address - Street 2:SUITE 100
Practice Address - City:MERIDIAN
Practice Address - State:ID
Practice Address - Zip Code:83646-7290
Practice Address - Country:US
Practice Address - Phone:208-895-0022
Practice Address - Fax:208-898-9308
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-02-05
Last Update Date:2013-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDPT-1978225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty