Healthcare Provider Details

I. General information

NPI: 1417370842
Provider Name (Legal Business Name): CHIEF TAHGEE ELEMENTARY ACADEMY, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/21/2014
Last Update Date: 12/05/2025
Certification Date: 12/05/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

38 S. HILINE ROAD
POCATELLO ID
83203
US

IV. Provider business mailing address

38 S. HILINE ROAD PO BOX 217
FORT HALL ID
83203
US

V. Phone/Fax

Practice location:
  • Phone: 208-237-2710
  • Fax: 208-237-1734
Mailing address:
  • Phone: 208-237-2710
  • Fax: 208-237-1734

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code103TS0200X
TaxonomySchool Psychologist
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code251300000X
TaxonomyLocal Education Agency (LEA)
License Number
License Number State

VIII. Authorized Official

Name: MR. DAVID MIRHADI
Title or Position: PRINCIPAL
Credential: M.ED.
Phone: 208-237-2710