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Organization
STATE OF IDAHO
Active
Organization
STATE OF IDAHO
Active
Other names
DHW IDAHO STATE SCHOOL AND HOPSITAL
Organization subpart
No
Provider details
NPI number
Authorized official
SUE BROETJE (ADMINISTRATIVE DIRECTOR)
(208) 442-2812
Entity
Organization
Contact information
Practice address
1660 11TH AVE N, NAMPA, ID 83687-5000
(208) 442-2812
(208) 467-5978
Mailing address
1660 11TH AVE N, NAMPA, ID 83687-5000
(208) 442-2812
(208) 467-5978
Taxonomy
Speciality
Code
Description
License number
State
315P00000X
Intellectual Disabilities Intermediate Care Facility
Primary
01
ID
Other
Enumeration date
03/21/2007
Last updated
08/22/2020
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