NPI 1083480404

Lucas Smith

Practitioner Child Intellectual and/or Developmental Disabilities Respite Care Blackfoot, ID

Practice location

Address: 861 Lakeside Dr, Blackfoot, ID 83221-1674
Phone: (208) 360-7355

Registered specialties

Child Intellectual and/or Developmental Disabilities Respite Care Primary

Respite Care Facility Taxonomy 385HR2060X

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Registry record

NPI: 1083480404
Entity type: Individual
Sex (as registered): Male
NPI issued: 27 Nov 2023
Record last updated: 27 Nov 2023

Reproduced from NPPES, the federal provider registry. The date above is when the provider last updated their own entry, not when we fetched it - a record can be years old and still current in the registry.