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General NPI Number Information
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NPI Number | 1528197514
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Entity Type | Organization
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Legal Business Name | IDAHO DEPT. OF HEALTH & WELFARE REG II CMH LEWISTON
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Dates
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Enumeration Date | 03/05/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 1118 F ST DRAWER B
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City | LEWISTON
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State | ID
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Zip | 83501-1930
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Country | US
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Telephone | 208-799-4360
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Fax | 208-799-3317
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Provider Business Mailing Address
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Address Line | 1118 F ST DRAWER B
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City | LEWISTON
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State | ID
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Zip | 83501-1930
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Country | US
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Telephone | 208-799-4360
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Fax | 208-799-3317
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Authorized Official
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Title or Position | PROGRAM MANAGER
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Name | VICKI R. MALONE
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Credential | MSW
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Telephone | 208-799-4440
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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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