Provider Demographics
NPI:1861854382
Name:WATCHDOG LLC
Entity Type:Organization
Organization Name:WATCHDOG LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:
Authorized Official - Last Name:TENCZA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:208-401-6440
Mailing Address - Street 1:730 W USTICK RD
Mailing Address - Street 2:SUITE #130
Mailing Address - City:MERIDIAN
Mailing Address - State:ID
Mailing Address - Zip Code:83646-5941
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:730 W USTICK RD
Practice Address - Street 2:SUITE #130
Practice Address - City:MERIDIAN
Practice Address - State:ID
Practice Address - Zip Code:83646-5941
Practice Address - Country:US
Practice Address - Phone:208-401-6440
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-03-23
Last Update Date:2016-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333300000XSuppliersEmergency Response System Companies
Provider Identifiers
StateIdentifier IDID TypeIssuer
IDM8078984Medicaid