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General NPI Number Information
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NPI Number | 1871724328
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Entity Type | Organization
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Legal Business Name | CATHOLIC CHARITIES OF IDAHO
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Dates
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Enumeration Date | 07/31/2009
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Last Update Date | 11/05/2019
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Provider Practice Location Address
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Address Line | 7255 W FRANKLIN RD
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City | BOISE
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State | ID
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Zip | 83709-0926
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Country | US
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Telephone | 208-345-6031
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 190123
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City | BOISE
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State | ID
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Zip | 83719-0123
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Country | US
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Telephone | 208-345-6031
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Fax | 208-350-7499
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Authorized Official
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Title or Position | CLINICAL SUPERVISOR
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Name | MATTHEW GESKE
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Credential |
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Telephone | 208-841-3000
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 104100000X
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Taxonomy Name | Social Worker
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License Number |
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License Number State |
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