Healthcare Provider Details

I. General information

NPI: 1487869939
Provider Name (Legal Business Name): WITCO, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/10/2007
Last Update Date: 06/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

122 W. GEORGIA AVENUE
NAMPA ID
83686-2864
US

IV. Provider business mailing address

3919 E USTICK RD
CALDWELL ID
83605-6508
US

V. Phone/Fax

Practice location:
  • Phone: 208-454-3051
  • Fax: 208-454-3053
Mailing address:
  • Phone: 208-454-3051
  • Fax: 208-454-3053

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: MS. MAUREEN ELLEN STOKES
Title or Position: PRESIDENT & CEO
Credential:
Phone: 208-454-3051