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General NPI Number Information
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NPI Number | 1649393810
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Entity Type | Organization
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Legal Business Name | SPRINGFIELD DEVELOPMENT
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Dates
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Enumeration Date | 04/10/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 220 E 37TH ST STE A
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City | BOISE
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State | ID
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Zip | 83714-3414
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Country | US
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Telephone | 208-345-7160
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Fax | 208-343-1064
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Provider Business Mailing Address
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Address Line | 220 E 37TH ST STE A
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City | BOISE
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State | ID
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Zip | 83714-3414
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Country | US
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Telephone | 208-345-7160
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Fax | 208-343-1064
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | MR. LOREN WHEELER
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Credential |
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Telephone | 205-345-7160
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251B00000X
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Taxonomy Name | Case Management Agency
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License Number | 0027717
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License Number State | ID
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