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General NPI Number Information
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NPI Number | 1124174941
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Entity Type | Organization
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Legal Business Name | TETON FAMILY SERVICES, INC.
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Dates
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Enumeration Date | 01/26/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 1030 E SUBLETTE ST
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City | POCATELLO
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State | ID
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Zip | 83201-5269
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Country | US
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Telephone | 208-232-5787
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Fax | 208-232-2638
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Provider Business Mailing Address
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Address Line | 1030 E SUBLETTE ST PO BOX 4669
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City | POCATELLO
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State | ID
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Zip | 83201-5269
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Country | US
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Telephone | 208-232-5787
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Fax | 208-232-2638
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | MR. RONALD BRET HAMILTON
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Credential | L.S.W.
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Telephone | 208-233-4166
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number |
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License Number State | ID
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