Active NPI
Eagle Crest Life Services Inc
- Psychiatry Physician
- Coeur d'Alene, ID
National Provider Identifier
1356500649
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Psychiatry Physician
- Legal business name
- EAGLE CREST LIFE SERVICES INC
- Practice address
- 212 S 11TH St Ste 3
Coeur D Alene, ID 83814-4000 - Phone
- (208) 666-9162
- NPI assigned
- Jun 3, 2008
- Last updated
- Feb 20, 2009
- Organization subpart
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Authorized official
- Name
- Robert K Wheeler
- Title
- Owner
- Phone
- (208) 666-9162
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Psychiatry Physician | 2084P0800X | NU | Primary |
Addresses
Primary practice location
212 S 11TH St Ste 3
Coeur D Alene, ID 83814-4000
Mailing address
PO Box 3723
Coeur D Alene, ID 83816-2529
Phone (208) 666-9162
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 807336200 | Medicaid | ID |
National Provider Directory
National Provider Directory- Tax ID family
- Eagle Crest Life Services
Other organizations with this tax ID 3
Organizations that report the same tax identification number in the National Provider Directory.
-
- Case Management Agency
- Coeur d'Alene, ID
- NPI 1336355783
-
- Prescribing (Medical) Psychologist
- Coeur d'Alene, ID
- NPI 1659572493
-
dba Ecls
- Community/Behavioral Health Agency
- Coeur d'Alene, ID
- NPI 1659492429
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1212451200000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1235088000000",
"number": "1356500649",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 3723",
"city": "COEUR D ALENE",
"state": "ID",
"postal_code": "838162529",
"telephone_number": "208-666-9162"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "212 S 11TH ST STE 3",
"city": "COEUR D ALENE",
"state": "ID",
"postal_code": "838144000",
"telephone_number": "208-666-9162"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "EAGLE CREST LIFE SERVICES INC",
"organizational_subpart": "NO",
"enumeration_date": "2008-06-03",
"last_updated": "2009-02-20",
"status": "A",
"authorized_official_last_name": "WHEELER",
"authorized_official_first_name": "ROBERT",
"authorized_official_middle_name": "K",
"authorized_official_title_or_position": "OWNER",
"authorized_official_telephone_number": "208-666-9162"
},
"taxonomies": [
{
"code": "2084P0800X",
"taxonomy_group": "",
"desc": "Psychiatry & Neurology, Psychiatry",
"state": "NU",
"license": null,
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "807336200",
"state": "ID"
}
],
"endpoints": [],
"other_names": []
}Other providers in Coeur d'Alene, ID
- Ashley Marie Duvall, NP
- Cameron Dwyer, DC
- Amanda Katherine Dyer, BCBA
- Eagle Crest Life Services
- Eagle Crest Life Services
- Eagle Crest Life Services, Inc. (Ecls)
- Eagle Eye Vision Services (DBA - Roy L. Clapper, OD)
- Ear, Nose & Throat of Coeur D'Alene, PA
- Samantha Anne Easterly, DO
- Curtis Eastin, D.D.S.
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 20, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.