Restoration Wellness of Idaho LLC

Primary specialty

Pastoral CounselorTaxonomy code 101YP1600X

Legal business name

RESTORATION WELLNESS OF IDAHO LLC

Practice address

3164 E Eastgate Dr
Boise, ID 83716-5637

Phone

(208) 794-4737

NPI assigned

Aug 17, 2024

Last updated

Aug 17, 2024By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Mrs. Melanie Elish Long-Azary

Title

Owner

Phone

(208) 794-4737

Specialties & licenses 5

Addresses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1723852800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1723852800000",
    "number": "1386476380",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 171362",
            "city": "BOISE",
            "state": "ID",
            "postal_code": "837171362",
            "telephone_number": "208-794-4737"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3164 E EASTGATE DR",
            "city": "BOISE",
            "state": "ID",
            "postal_code": "837165637",
            "telephone_number": "208-794-4737"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "RESTORATION WELLNESS OF IDAHO LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2024-08-17",
        "last_updated": "2024-08-17",
        "certification_date": "2024-08-17",
        "status": "A",
        "authorized_official_last_name": "LONG-AZARY",
        "authorized_official_first_name": "MELANIE",
        "authorized_official_middle_name": "ELISH",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "208-794-4737",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "101YA0400X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Counselor, Addiction (Substance Use Disorder)",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "101YP1600X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Counselor, Pastoral",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "171M00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Case Manager/Care Coordinator",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "171R00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Interpreter",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "175T00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Peer Specialist",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 17, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.