Provider Demographics
NPI:1053938779
Name:HALO HEALTH SERVICES LLC
Entity type:Organization
Organization Name:HALO HEALTH SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MISS
Authorized Official - First Name:FARHIA
Authorized Official - Middle Name:DIRANE
Authorized Official - Last Name:MOHAMED
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:206-643-9484
Mailing Address - Street 1:1111 S ORCHARD ST STE 152
Mailing Address - Street 2:
Mailing Address - City:BOISE
Mailing Address - State:ID
Mailing Address - Zip Code:83705-1963
Mailing Address - Country:US
Mailing Address - Phone:206-643-9484
Mailing Address - Fax:
Practice Address - Street 1:1111 S ORCHARD ST, BOISE, ID 83705
Practice Address - Street 2:
Practice Address - City:BOISE
Practice Address - State:ID
Practice Address - Zip Code:83705
Practice Address - Country:US
Practice Address - Phone:206-643-9484
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-06-29
Last Update Date:2020-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health