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NORTHSIDE COUNSELING & REHAB

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Company Details

Name: NORTHSIDE COUNSELING & REHAB
Jurisdiction: Idaho
Legal type: Assumed Business Name
Status: Active-Current
Date of registration: 21 Nov 2008 (17 years ago)
Entity Number: 387198
Place of Formation: IDAHO
File Number: 0000387198
ZIP code: 83301
County: Twin Falls County
Mailing Address: 801 NORTH LINCOLN ST JEROME, ID 83301

National Provider Identifier

NPI Number:
1336394683

Authorized Person:

Name:
MS. MARYLIN EACKER
Role:
MANAGING MEMBER
Phone:

Taxonomy:

Selected Taxonomy:
251S00000X - Community/Behavioral Health Agency
Is Primary:
Yes

Contacts:

Filing

Filing Name Filing Number Filing date
Initial Filing 0000387198 2008-11-21

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Date of last update: 25 Sep 2024

Sources: Idaho Secretary of State