Organization Name: | IDAHODHWBH3 CALD AMH PSR |
NPI Number: | 1023146529 |
Entity Type Code: | Organizational (2) |
Authorized Official Name: | TODD L HURT (FIELD OPERATIOINS MANAGER) |
Mailing Address: | 3402 Franklin Rd Caldwell |
State: | ID US |
Postal Code: | 836056932 |
Phone Number: | 2084590092 |
Fax Number: | 2084547714 |
NPI Enumeration Date: | 02/28/2007 |
NPI Last Update Date: | 07/08/2007 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 261QM0801X |
License Number: | |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | |
Taxonomy Type: | Ambulatory Health Care Facilities |
Taxonomy Classification: | Clinic/Center |
Taxonomy Specialization: | Mental Health (Including Community Mental Health Center) |
Taxonomy Definition: |