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General NPI Number Information
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NPI Number | 1194115378
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Entity Type | Organization
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Legal Business Name | CASE MANAGERS OF IDAHO, LLC
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Dates
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Enumeration Date | 01/27/2015
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Last Update Date | 02/12/2016
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Provider Practice Location Address
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Address Line | 1111 S ORCHARD ST SUITE #157
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City | BOISE
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State | ID
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Zip | 83705-1966
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Country | US
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Telephone | 208-982-7701
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Fax | 208-209-7186
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Provider Business Mailing Address
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Address Line | 1111 S ORCHARD ST SUITE #157
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City | BOISE
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State | ID
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Zip | 83705-1966
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Country | US
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Telephone | 208-982-7701
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Fax | 208-209-7186
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Authorized Official
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Title or Position | PRESIDENT
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Name | MR. PATRICK TIMOTHY KIRK
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Credential | B.A.
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Telephone | 208-982-7701
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251B00000X
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Taxonomy Name | Case Management Agency
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License Number |
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License Number State | ID
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