Provider Demographics
NPI:1245951540
Name:AMAZING ASSESSMENTS & EXCEPTIONAL EVALUATIONS
Entity type:Organization
Organization Name:AMAZING ASSESSMENTS & EXCEPTIONAL EVALUATIONS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/OPERATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:JOSHUA
Authorized Official - Middle Name:JOHN
Authorized Official - Last Name:WILDING
Authorized Official - Suffix:
Authorized Official - Credentials:CADC
Authorized Official - Phone:208-599-4245
Mailing Address - Street 1:5732 W DURNING DR
Mailing Address - Street 2:
Mailing Address - City:EAGLE
Mailing Address - State:ID
Mailing Address - Zip Code:83616-6238
Mailing Address - Country:US
Mailing Address - Phone:208-599-4245
Mailing Address - Fax:
Practice Address - Street 1:5732 W DURNING DR
Practice Address - Street 2:
Practice Address - City:EAGLE
Practice Address - State:ID
Practice Address - Zip Code:83616-6238
Practice Address - Country:US
Practice Address - Phone:208-599-4245
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-09-06
Last Update Date:2022-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
ID15684190Medicaid