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General NPI Number Information
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NPI Number | 1396921581
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Entity Type | Organization
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Legal Business Name | MERIDIAN DEVELOPMENTAL SERVICES LLC
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Dates
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Enumeration Date | 01/17/2008
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Last Update Date | 01/17/2008
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Provider Practice Location Address
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Address Line | 40 W FRANKLIN RD STE I
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City | MERIDIAN
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State | ID
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Zip | 83642-2992
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Country | US
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Telephone | 208-888-6068
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Fax | 208-888-6055
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Provider Business Mailing Address
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Address Line | 40 W FRANKLIN RD STE I
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City | MERIDIAN
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State | ID
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Zip | 83642-2992
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Country | US
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Telephone | 208-888-6068
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Fax | 208-888-6055
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Authorized Official
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Title or Position | PROGRAM MANAGER
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Name | MS. KRISTIE MOWRY
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Credential |
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Telephone | 208-888-6068
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251C00000X
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Taxonomy Name | Developmentally Disabled Services Day Training Agency
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License Number |
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License Number State | ID
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