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General NPI Number Information
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NPI Number | 1366844409
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Entity Type | Organization
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Legal Business Name | ALZHEIMER DEMENTIA CENTER
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Dates
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Enumeration Date | 09/19/2014
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Last Update Date | 09/19/2014
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Provider Practice Location Address
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Address Line | 6121 CLEVELAND BLVD
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City | CALDWELL
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State | ID
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Zip | 83607-5129
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Country | US
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Telephone | 208-991-2551
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Fax |
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Provider Business Mailing Address
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Address Line | 723 ROYAL ST
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City | CALDWELL
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State | ID
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Zip | 83605-1665
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Country | US
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Telephone | 208-991-2551
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Fax |
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Authorized Official
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Title or Position | PROGRAM DIRECTOR
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Name | MR. CHARLES WILLIAMS
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Credential |
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Telephone | 208-991-2551
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QA0600X
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Taxonomy Name | Adult Day Care Clinic/Center
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License Number |
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License Number State |
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