Healthcare Provider Details

I. General information

NPI: 1801428917
Provider Name (Legal Business Name): NORTHWEST CHILDREN'S HOME
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/06/2020
Last Update Date: 02/18/2020
Certification Date: 02/18/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

602 13TH ST
LEWISTON ID
83501-2586
US

IV. Provider business mailing address

419 22ND AVE
LEWISTON ID
83501-3812
US

V. Phone/Fax

Practice location:
  • Phone: 208-746-8206
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YS0200X
TaxonomySchool Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code1041S0200X
TaxonomySchool Social Worker
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State

VIII. Authorized Official

Name: JENNIFER SKEELS
Title or Position: BUSINESS OFFICE MANAGER
Credential:
Phone: 208-743-9404