1265216436 NPI number — RESILIENCY RISING LLC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1265216436 NPI number — RESILIENCY RISING LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
RESILIENCY RISING LLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1265216436
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/21/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 426
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
HAILEY
Provider Business Mailing Address State Name:
ID
Provider Business Mailing Address Postal Code:
83333-0400
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
208-481-4639
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
208 SPRUCE AVE. N.
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
KETCHUM
Provider Business Practice Location Address State Name:
ID
Provider Business Practice Location Address Postal Code:
83340
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
208-481-4639
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
08/21/2023

Additional Information

Authorized Official

Authorized Official Last Name:
STRAND
Authorized Official First Name:
LAURIE
Authorized Official Middle Name:
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
208-481-4639

Provider Taxonomy Codes

  • Taxonomy code: 1041C0700X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 39026 . This is a "UNITED MEDICAL RESOURCES" identifier . This identifiers is of the category "OTHER".
  • Identifier: 93029 . This is a "PACIFICSOURCE HEALTH PLANS" identifier , issued by the state of ( ID ) . This identifiers is of the category "OTHER".
  • Identifier: IDBLC . This is a "BLUE CROSS BLUE SHIELD OF IDAHO" identifier , issued by the state of ( ID ) . This identifiers is of the category "OTHER".
  • Identifier: NCBLS . This is a "BLUE CROSS BLUE SHIELD OF NORTH CAROLINA" identifier , issued by the state of ( ID ) . This identifiers is of the category "OTHER".
  • Identifier: RGBLS . This is a "REGENCE BLUE SHIELD OF WASHINGTON" identifier , issued by the state of ( ID ) . This identifiers is of the category "OTHER".
  • Identifier: IDBLS . This is a "BLUE SHIELD OF IDAHO" identifier , issued by the state of ( ID ) . This identifiers is of the category "OTHER".
  • Identifier: RGA01 . This is a "REGENCE GROUP ADMINISTRATORS" identifier . This identifiers is of the category "OTHER".
  • Identifier: UH107 . This is a "SELECTHEALTH" identifier . This identifiers is of the category "OTHER".
  • Identifier: 39026 . This is a "UMR" identifier . This identifiers is of the category "OTHER".
  • Identifier: SX155 . This is a "MOUNTAIN HEALTH CO-OP" identifier , issued by the state of ( ID ) . This identifiers is of the category "OTHER".
  • Identifier: 84076 . This is a "SINCLAIR HEALTH PLAN" identifier . This identifiers is of the category "OTHER".
  • Identifier: IDBLC . This is a "BLUE CROSS OF IDAHO" identifier . This identifiers is of the category "OTHER".
  • Identifier: WABLC . This is a "WASHINGTON STATE PREMERA BLUE CROSS" identifier . This identifiers is of the category "OTHER".
  • Identifier: 60054 . This is a "AETNA" identifier , issued by the state of ( ID ) . This identifiers is of the category "OTHER".
  • Identifier: SX155 . This is a "UNIVERSITY OF UTAH HEALTH PLANS" identifier . This identifiers is of the category "OTHER".
  • Identifier: SX155 . This is a "UNIVERSITY OF UTAH" identifier . This identifiers is of the category "OTHER".
  • Identifier: BC001 . This is a "ANTHEM BLUE CROSS OF CALIFORNIA" identifier . This identifiers is of the category "OTHER".
  • Identifier: UH107 . This is a "SELECT HEALTH IHC INTERMOUNTAIN HEALTH" identifier . This identifiers is of the category "OTHER".




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