Provider Demographics
NPI:1871367276
Name:TANTA INC
Entity type:Organization
Organization Name:TANTA INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:RAMATOULIE
Authorized Official - Middle Name:
Authorized Official - Last Name:DEEN
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:208-333-8333
Mailing Address - Street 1:413 W IDAHO ST STE 302
Mailing Address - Street 2:
Mailing Address - City:BOISE
Mailing Address - State:ID
Mailing Address - Zip Code:83702-6066
Mailing Address - Country:US
Mailing Address - Phone:208-385-7233
Mailing Address - Fax:208-344-7233
Practice Address - Street 1:413 W IDAHO ST STE 302
Practice Address - Street 2:
Practice Address - City:BOISE
Practice Address - State:ID
Practice Address - Zip Code:83702-6066
Practice Address - Country:US
Practice Address - Phone:208-333-8333
Practice Address - Fax:208-344-7233
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-11-07
Last Update Date:2024-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health