Organization Name: | IDAHO DEPT OF HEALTH & WELFARE REGION 7 CMH PSR SALMON |
NPI Number: | 1417083833 |
Entity Type Code: | Organizational (2) |
Authorized Official Name: | MELISSA M BEAN (PROGRAM MANAGER) |
Mailing Address: | 1301 Main St Salmon |
State: | ID US |
Postal Code: | 834674451 |
Phone Number: | 2087563336 |
Fax Number: | 2087563805 |
NPI Enumeration Date: | 02/27/2007 |
NPI Last Update Date: | 07/08/2007 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 261QR0400X |
License Number: | |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | |
Taxonomy Type: | Ambulatory Health Care Facilities |
Taxonomy Classification: | Clinic/Center |
Taxonomy Specialization: | Rehabilitation |
Taxonomy Definition: |