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General NPI Number Information
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NPI Number | 1245781053
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Entity Type | Organization
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Legal Business Name | IDACARE
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Dates
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Enumeration Date | 10/17/2016
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Last Update Date | 05/18/2019
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Provider Practice Location Address
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Address Line | 2206 N COLE RD
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City | BOISE
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State | ID
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Zip | 83704-7313
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Country | US
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Telephone | 208-451-0101
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 1127
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City | MCCALL
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State | ID
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Zip | 83638-1127
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Country | US
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Telephone | 208-451-0101
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Fax |
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Authorized Official
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Title or Position | DIRECTOR
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Name | SHAWN JOYCE BRILEY
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Credential | LCSW
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Telephone | 208-451-0101
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number |
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License Number State |
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