| NPI | 1255602983 |
|---|---|
| Other Name | LIFESTAR POCATELLO AND IDAHO FALLS |
| Entity Type | Organization |
| Authorized Contact | DAVID COVEY Owner 208-520-9649 |
| Organization Subpart ? | No |
| Primary Taxonomy | 101Y00000X Counselor |
| Enumeration Date | 2012-01-26 |
| Last Update Date | 2012-02-23 |