Provider Demographics
NPI:1831914712
Name:LAVOI LANDING
Entity type:Organization
Organization Name:LAVOI LANDING
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ALISA
Authorized Official - Middle Name:
Authorized Official - Last Name:LAVOI
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:773-315-5020
Mailing Address - Street 1:4458 E FACETO ST
Mailing Address - Street 2:
Mailing Address - City:MERIDIAN
Mailing Address - State:ID
Mailing Address - Zip Code:83642-5720
Mailing Address - Country:US
Mailing Address - Phone:775-315-5020
Mailing Address - Fax:
Practice Address - Street 1:2484 N STOKESBERRY PL
Practice Address - Street 2:
Practice Address - City:MERIDIAN
Practice Address - State:ID
Practice Address - Zip Code:83646-6085
Practice Address - Country:US
Practice Address - Phone:775-315-5020
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-11-18
Last Update Date:2024-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
ID1972266815OtherNPPES