Provider Demographics
NPI:1912896259
Name:SANCTUARY OF INTEGRATIVE WELLBEING
Entity type:Organization
Organization Name:SANCTUARY OF INTEGRATIVE WELLBEING
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:
Authorized Official - Last Name:DIONA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:715-790-0823
Mailing Address - Street 1:207 SKY MEADOW RD
Mailing Address - Street 2:
Mailing Address - City:SAGLE
Mailing Address - State:ID
Mailing Address - Zip Code:83860-9296
Mailing Address - Country:US
Mailing Address - Phone:715-790-0823
Mailing Address - Fax:
Practice Address - Street 1:207 SKY MEADOW RD
Practice Address - Street 2:
Practice Address - City:SAGLE
Practice Address - State:ID
Practice Address - Zip Code:83860-9296
Practice Address - Country:US
Practice Address - Phone:715-790-0823
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-07-01
Last Update Date:2025-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center