Provider Demographics
NPI:1982126264
Name:BRC MENTAL HEALTH SERVICES
Entity Type:Organization
Organization Name:BRC MENTAL HEALTH SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MELISSA
Authorized Official - Middle Name:M
Authorized Official - Last Name:WOLFE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:208-890-7290
Mailing Address - Street 1:PO BOX 1349
Mailing Address - Street 2:
Mailing Address - City:EAGLE
Mailing Address - State:ID
Mailing Address - Zip Code:83616-1349
Mailing Address - Country:US
Mailing Address - Phone:208-890-7290
Mailing Address - Fax:208-286-9829
Practice Address - Street 1:963 S ORCHARD ST STE 103
Practice Address - Street 2:
Practice Address - City:BOISE
Practice Address - State:ID
Practice Address - Zip Code:83705-1917
Practice Address - Country:US
Practice Address - Phone:208-890-7290
Practice Address - Fax:208-286-9829
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-07-08
Last Update Date:2019-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health