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General NPI Number Information
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NPI Number | 1467679035
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Entity Type | Organization
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Legal Business Name | CHILDRENS SUPPORTIVE SERVICES INCORPORATED
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Dates
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Enumeration Date | 04/18/2007
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Last Update Date | 12/02/2009
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Provider Practice Location Address
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Address Line | 625 W PACIFIC ST SUITE 2
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City | BLACKFOOT
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State | ID
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Zip | 83221-2034
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Country | US
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Telephone | 208-524-8996
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Fax | 208-524-1205
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Provider Business Mailing Address
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Address Line | 1565 E LINCOLN RD
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City | IDAHO FALLS
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State | ID
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Zip | 83401-2129
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Country | US
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Telephone | 208-524-8996
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Fax | 208-524-1205
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Authorized Official
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Title or Position | SECRETARY-TREASURER
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Name | CATHIE CRANE
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Credential |
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Telephone | 208-524-8996
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number |
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License Number State |
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