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General NPI Number Information
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NPI Number | 1356484505
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Entity Type | Organization
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Legal Business Name | IDAHO DEPT OF HEALTH & WELFARE ESC REGION 7
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Dates
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Enumeration Date | 02/15/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 2475 LESLIE AVE
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City | IDAHO FALLS
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State | ID
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Zip | 83402-4517
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Country | US
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Telephone | 208-525-7223
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Fax | 208-525-7176
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Provider Business Mailing Address
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Address Line | 2475 LESLIE AVE
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City | IDAHO FALLS
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State | ID
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Zip | 83402-4517
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Country | US
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Telephone | 208-525-7223
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Fax | 208-525-7176
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Authorized Official
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Title or Position | PROGRAM MANAGER
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Name | MS. MARY J JONES
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Credential | B.U.S.
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Telephone | 208-334-5523
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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 |
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