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NPI Code Detail

MEDICARE: CATHOLIC CHARITIES OF IDAHO

MEDICARE: CATHOLIC CHARITIES OF IDAHO
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1104100000XSocial Worker

General Provider Information

NPI Number : 1871724328
Entity Type Code : Organization
Provider Name (Legal Business Name) : CATHOLIC CHARITIES OF IDAHO
Provider Business Mailing Address
First Line : PO BOX 190123
Second Line :
City : BOISE
State : ID
Zip : 83719-0123
Country : US
Telephone Number : 208-345-6031
Fax Number : 208-350-7499
Provider Business Practice Location Address
First Line : 7255 W FRANKLIN RD
Second Line :
City : BOISE
State : ID
Zip : 83709-0926
Country : US
Telephone Number : 208-345-6031
Fax Number :
Authorized Official
Title or Position : CLINICAL SUPERVISOR
Name : MATTHEW GESKE
Credential :
Telephone Number : 208-841-3000
Provider Enumeration Date : 07/31/2009
Last Update Date : 11/05/2019

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Directions to “CATHOLIC CHARITIES OF IDAHO ” Practice Location

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