Healthcare Provider Details

I. General information

NPI: 1104948322
Provider Name (Legal Business Name): DEVELOPMENT WORKSHOP, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/06/2007
Last Update Date: 06/11/2025
Certification Date: 06/11/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

555 W 25TH ST
IDAHO FALLS ID
83402-4527
US

IV. Provider business mailing address

555 W 25TH ST
IDAHO FALLS ID
83402-4527
US

V. Phone/Fax

Practice location:
  • Phone: 208-524-1550
  • Fax: 208-523-3148
Mailing address:
  • Phone: 208-524-1550
  • Fax: 208-523-3148

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251C00000X
TaxonomyDevelopmentally Disabled Services Day Training Agency
License Number02396600
License Number StateID
# 2
Primary TaxonomyN
Taxonomy Code261QA0600X
TaxonomyAdult Day Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MCKAYLA MATLACK
Title or Position: CEO
Credential:
Phone: 208-524-1550