Provider Demographics
NPI:1184807190
Name:ACCESS LIFE RESOURCE, INC.
Entity type:Organization
Organization Name:ACCESS LIFE RESOURCE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MS
Authorized Official - First Name:JULENE
Authorized Official - Middle Name:B
Authorized Official - Last Name:KNAPP
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:208-338-1227
Mailing Address - Street 1:3370 CHICKORY WAY
Mailing Address - Street 2:
Mailing Address - City:BOISE
Mailing Address - State:ID
Mailing Address - Zip Code:83706-5266
Mailing Address - Country:US
Mailing Address - Phone:208-336-2208
Mailing Address - Fax:208-338-1228
Practice Address - Street 1:960 BROADWAY AVE
Practice Address - Street 2:SUITE 435
Practice Address - City:BOISE
Practice Address - State:ID
Practice Address - Zip Code:83706-3600
Practice Address - Country:US
Practice Address - Phone:208-338-1227
Practice Address - Fax:208-338-1228
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-12
Last Update Date:2007-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
ID1378814Medicare PIN