Provider Demographics
NPI:1811153844
Name:EDWISE LLC
Entity type:Organization
Organization Name:EDWISE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CO-PRESIDENT
Authorized Official - Prefix:MS
Authorized Official - First Name:PAMELA
Authorized Official - Middle Name:DAWN
Authorized Official - Last Name:HOUSTON-POWELL
Authorized Official - Suffix:
Authorized Official - Credentials:EDS
Authorized Official - Phone:208-308-2410
Mailing Address - Street 1:1511 BUSCH CT
Mailing Address - Street 2:
Mailing Address - City:TWIN FALLS
Mailing Address - State:ID
Mailing Address - Zip Code:83301-3476
Mailing Address - Country:US
Mailing Address - Phone:208-308-2410
Mailing Address - Fax:208-326-4343
Practice Address - Street 1:132 FALLS AVE W
Practice Address - Street 2:#103
Practice Address - City:TWIN FALLS
Practice Address - State:ID
Practice Address - Zip Code:83301-3359
Practice Address - Country:US
Practice Address - Phone:208-308-2410
Practice Address - Fax:208-326-4343
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-07-30
Last Update Date:2008-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251C00000XAgenciesDay Training, Developmentally Disabled Services
No251S00000XAgenciesCommunity/Behavioral Health