Organization Name: | IDAHO DEPT OF HEALTH & WELFARE REG 1 AMH |
NPI Number: | 1710284047 |
Entity Type Code: | Organizational (2) |
Authorized Official Name: | VICKI MALONE (PROGRAM MANAGER) |
Mailing Address: | 222 S 7th St St Maries |
State: | ID US |
Postal Code: | 838611847 |
Phone Number: | 2082452541 |
Fax Number: | 2082457131 |
NPI Enumeration Date: | 02/23/2011 |
NPI Last Update Date: | 02/23/2011 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 261QM0850X |
License Number: | |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | |
Taxonomy Type: | Ambulatory Health Care Facilities |
Taxonomy Classification: | Clinic/Center |
Taxonomy Specialization: | Adult Mental Health |
Taxonomy Definition: | An entity, facility, or distinct part of a facility providing diagnostic, treatment, and prescriptive services related to mental and behavioral disorders in adults. |