IndividualActive
Lucas Smith
NPI 1083480404 · Child Intellectual and/or Developmental Disabilities Respite Care · Blackfoot, ID
Provider details
- NPI number
- 1083480404
- Entity type
- Individual
- Primary specialty
- Child Intellectual and/or Developmental Disabilities Respite CareRespite Care Facility
- Sex
- Male
- Sole proprietor
- Yes
Specialties & taxonomies
Respite Care Facility
Practice location
861 Lakeside Dr
Blackfoot, ID 83221-1674
Phone: (208) 360-7355
Approximate (ZIP-level) locationGet directions
Mailing address
861 Lakeside Dr
Blackfoot, ID 83221-1674
Registry dates
- Enumerated
- 2023-11-27
- Last updated
- 2023-11-27
- Certified
- 2023-11-27
Source: CMS NPPES Data Dissemination (June 2026). NPI Central is not affiliated with CMS. Data is provided as-is from the public registry.