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General NPI Number Information
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NPI Number | 1710009246
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Entity Type | Organization
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Legal Business Name | ID DEPT OF HEALTH & WELFARE CSHP (ACF)
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Dates
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Enumeration Date | 04/04/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 100 E IDAHO ST STE 200
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City | BOISE
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State | ID
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Zip | 83712-6223
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Country | US
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Telephone | 208-381-7092
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Fax | 208-381-7002
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Provider Business Mailing Address
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Address Line | PO BOX 83720 4TH FLOOR
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City | BOISE
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State | ID
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Zip | 83720-0036
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Country | US
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Telephone | 208-334-4935
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Fax | 208-332-7307
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Authorized Official
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Title or Position | ACTING PROGRAM MANAGER
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Name | PAIGE FINCHER
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Credential | BSW
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Telephone | 208-334-4935
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number |
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License Number State |
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