Lost River Wellness

Primary specialty

Adult Mental Health Clinic/CenterTaxonomy code 261QM0850X

License

M11538 Issued in ID

Legal business name

LOST RIVER WELLNESS

Doing business as

Lost River Wellness

Practice address

3080 E Gentry Way Ste 100
Meridian, ID 83642-3060

Phone

(208) 810-2318

NPI assigned

Aug 18, 2018

Last updated

Nov 28, 2018By 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

Jeff Brown

Title

Chief Business Officer

Phone

(208) 484-1447

Specialties & licenses 1

Addresses

Other names 1

• Lost River Wellness Doing business as

Locations

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

{
    "created_epoch": "1534550400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1543363200000",
    "number": "1497235469",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3080 E GENTRY WAY STE 100",
            "city": "MERIDIAN",
            "state": "ID",
            "postal_code": "836423060",
            "telephone_number": "208-484-1447"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3080 E GENTRY WAY STE 100",
            "city": "MERIDIAN",
            "state": "ID",
            "postal_code": "836423060",
            "telephone_number": "208-810-2318"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LOST RIVER WELLNESS",
        "organizational_subpart": "NO",
        "enumeration_date": "2018-08-18",
        "last_updated": "2018-11-28",
        "status": "A",
        "authorized_official_last_name": "BROWN",
        "authorized_official_first_name": "JEFF",
        "authorized_official_title_or_position": "CHIEF BUSINESS OFFICER",
        "authorized_official_telephone_number": "208-484-1447"
    },
    "taxonomies": [
        {
            "code": "261QM0850X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Adult Mental Health",
            "state": "ID",
            "license": "M11538",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Lost River Wellness",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Lost River Wellness",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Tim R Loewenstein, PA
• Jane Susan Lomas, MS, CFY-CLP
• Jack A Long, D.C.
• Lynn D Longworth, RPH
• Lizveth Lopez, PHARMD
• Wendy Diane Loumeau, PA
• Caleb J Louvier, DPT, PT
• Ingrid Annelise Lovberg
• Erin Love McDermott, PA-C
• Delaney Love

• Adult Mental Health Clinic/Center in Meridian, ID
• Providers in Meridian, ID by specialty
• Adult Mental Health Clinic/Center in Idaho

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 28, 2018; 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.