IndividualActive
Tristin Dominguez
NPI 1225980568 · Child Mental Illness Respite Care · Lewiston, ID
Provider details
- NPI number
- 1225980568
- Entity type
- Individual
- Primary specialty
- Child Mental Illness Respite CareRespite Care Facility
- Sex
- Male
- Sole proprietor
- Yes
Specialties & taxonomies
Respite Care Facility
Practice location
531 Bryden Ave
Lewiston, ID 83501-4438
Phone: (208) 798-1646
Fax: (208) 798-5568
Approximate (ZIP-level) locationGet directions
Mailing address
531 Bryden Ave
Lewiston, ID 83501-4438
Registry dates
- Enumerated
- 2026-02-10
- Last updated
- 2026-02-10
- Certified
- 2026-02-10
Source: CMS NPPES Data Dissemination (June 2026). NPI Central is not affiliated with CMS. Data is provided as-is from the public registry.