| Organization Name: | IDAHO DEPT OF HEALTH & WELFARE REG. II AMH OROFINO |
| NPI Number: | 1235267055 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | VICKI R. MALONE (PROGRAM MANAGER) |
| Mailing Address: | 416 Johnson Ave Orofino |
| State: | ID US |
| Postal Code: | 835449516 |
| Phone Number: | 2084767703 |
| Fax Number: | 2084763636 |
| NPI Enumeration Date: | 03/01/2007 |
| 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: | |