# IDAHO DEPT OF HEALTH & WELFARE REG 2 CMH

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1407153737
- **Authorized official:** VICKI MALONE (PROGRAM MANAGER)
- **Authorized official phone:** (208) 799-4440

## Contact information

- **Practice address:** 216 S C ST, GRANGEVILLE, ID 83530-1342
- **Practice address phone:** (208) 983-2300
- **Mailing address:** PO BOX 548, GRANGEVILLE, ID 83530-0548
- **Mailing address phone:** (208) 983-2300

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 261QM0855X | Adolescent and Children Mental Health Clinic/Center | — | NULL | Yes |

## Other

- **Enumeration date:** 02/23/2011
- **Last updated:** 02/23/2011