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General NPI Number Information
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NPI Number | 1538567532
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Entity Type | Organization
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Legal Business Name | CHAROLAIS CARE VIII, INC
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Dates
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Enumeration Date | 12/08/2014
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Last Update Date | 12/08/2014
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Provider Practice Location Address
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Address Line | 650 ADDISON AVE W SUITE 400
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City | TWIN FALLS
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State | ID
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Zip | 83301-5851
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Country | US
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Telephone | 208-736-1050
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Fax | 208-733-2367
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Provider Business Mailing Address
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Address Line | 650 ADDISON AVE W SUITE 400
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City | TWIN FALLS
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State | ID
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Zip | 83301-5851
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Country | US
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Telephone | 208-736-1050
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Fax | 208-733-2367
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Authorized Official
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Title or Position | OFFICE MANAGER
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Name | ANGELA DAWN PASQUALE
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Credential |
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Telephone | 208-736-1050
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 3245S0500X
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Taxonomy Name | Children's Substance Abuse Rehabilitation Facility
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License Number | 38517
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License Number State | ID
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