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Organization
IDAHO DEPT OF HEALTH & WELFARE REG 1 CMH PSR CDA
Active
Organization
IDAHO DEPT OF HEALTH & WELFARE REG 1 CMH PSR CDA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
CORA JO GUSSENHOVEN (PROGRAM MANAGER)
(208) 769-1406
Entity
Organization
Contact information
Practice address
1250 IRONWOOD DR STE 100, COEUR D ALENE, ID 83814-2628
(208) 769-1515
(208) 666-6744
Mailing address
1250 IRONWOOD DR STE 100, COEUR D ALENE, ID 83814-2628
(208) 769-1515
(208) 666-6744
Taxonomy
Speciality
Code
Description
License number
State
261QR0400X
Rehabilitation Clinic/Center
Primary
—
NULL
Other
Enumeration date
03/01/2007
Last updated
08/22/2020
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