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General NPI Number Information
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NPI Number | 1245368224
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Entity Type | Organization
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Legal Business Name | NORTHWEST CHILDREN'S HOME
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Dates
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Enumeration Date | 03/01/2007
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Last Update Date | 02/06/2020
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Provider Practice Location Address
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Address Line | 419 22ND AVE
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City | LEWISTON
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State | ID
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Zip | 83501-3812
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Country | US
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Telephone | 208-743-9404
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Fax |
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Provider Business Mailing Address
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Address Line | 419 22ND AVE
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City | LEWISTON
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State | ID
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Zip | 83501-3812
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Country | US
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Telephone | 208-743-9404
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Fax |
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Authorized Official
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Title or Position | BUSINESS OFFICE MANGER
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Name | MRS. JENNY SKEELS
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Credential |
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Telephone | 208-743-9404
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | LCPC-2754
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License Number State | ID
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Taxonomy #2
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Taxonomy Code | 322D00000X
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Taxonomy Name | Emotionally Disturbed Childrens' Residential Treatment Facility
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License Number |
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License Number State |
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