Provider Demographics
NPI:1831308113
Name:ASPEN CENTER REHABILITATION AND COUNSELING LLC
Entity Type:Organization
Organization Name:ASPEN CENTER REHABILITATION AND COUNSELING LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MS
Authorized Official - First Name:KIM
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:SIX
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:208-354-3601
Mailing Address - Street 1:PO BOX 990
Mailing Address - Street 2:
Mailing Address - City:DRIGGS
Mailing Address - State:ID
Mailing Address - Zip Code:83422-0990
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:140 N. 1ST E
Practice Address - Street 2:
Practice Address - City:DRIGGS
Practice Address - State:ID
Practice Address - Zip Code:83442
Practice Address - Country:US
Practice Address - Phone:208-354-3601
Practice Address - Fax:208-354-3602
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-22
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)