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General NPI Number Information
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NPI Number | 1992789101
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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 | 12/01/2005
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Last Update Date | 05/08/2013
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Provider Practice Location Address
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Address Line | 700 EAST ALICE BOX 400
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City | BLACKFOOT
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State | ID
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Zip | 83221
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Country | US
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Telephone | 208-785-1200
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Fax | 208-785-8518
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Provider Business Mailing Address
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Address Line | 700 E ALICE ST PO BOX 400
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City | BLACKFOOT
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State | ID
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Zip | 83221-4925
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Country | US
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Telephone | 208-785-1200
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Fax | 208-785-8518
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Authorized Official
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Title or Position | HOSPITAL ADMINISTRATOR
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Name | MRS. TRACEY G. SESSIONS
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Credential |
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Telephone | 208-785-8402
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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 | #17
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License Number State | ID
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