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General NPI Number Information
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NPI Number | 1598831653
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Entity Type | Organization
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Legal Business Name | STATE OF IDAHO DEPARTMENT OF HEALTH AND WELFARE
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Dates
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Enumeration Date | 11/28/2006
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Last Update Date | 05/19/2025
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Provider Practice Location Address
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Address Line | 300 HOSPITAL DRIVE
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City | OROFINO
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State | ID
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Zip | 83544-9034
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Country | US
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Telephone | 208-476-4511
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Fax | 208-476-7898
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Provider Business Mailing Address
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Address Line | 300 HOSPITAL DRIVE
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City | OROFINO
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State | ID
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Zip | 83544-9034
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Country | US
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Telephone | 208-476-4511
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Fax | 208-476-7898
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Authorized Official
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Title or Position | INTERIM ADMINISTRATIVE DIRECTOR
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Name | DR. JENNIFER SHUFFIELD
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Credential | DSW, LCSW, CTP-C
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Telephone | 208-476-4511
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 283Q00000X
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Taxonomy Name | Psychiatric Hospital
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License Number | 24
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License Number State | ID
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