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General NPI Number Information
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NPI Number | 1508992926
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Entity Type | Organization
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Legal Business Name | IDAHO DEPT OF HEALTH & WELFARE REGION 7 CMH PSR REXBURG
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Dates
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Enumeration Date | 02/27/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 333 WALKER DR
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City | REXBURG
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State | ID
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Zip | 83440-1657
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Country | US
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Telephone | 208-359-4751
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Fax | 208-359-5461
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Provider Business Mailing Address
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Address Line | 333 WALKER DR
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City | REXBURG
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State | ID
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Zip | 83440-1657
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Country | US
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Telephone | 208-359-4751
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Fax | 208-359-5461
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Authorized Official
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Title or Position | PROGRAM MANGER
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Name | MRS. MELISSA M BEAN
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Credential | MA
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Telephone | 208-528-5706
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QR0400X
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Taxonomy Name | Rehabilitation Clinic/Center
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License Number |
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License Number State |
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