# IDAHO DEPT OF HEALTH & WELFARE REG II CMH GRANGEVILLE

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

## Provider details

- **NPI number:** 1427186063
- **Authorized official:** VICKI R. MALONE MSW (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
- **Practice address fax:** (208) 983-2400
- **Mailing address:** PO BOX 548, GRANGEVILLE, ID 83530-0548
- **Mailing address phone:** (208) 983-2300
- **Mailing address fax:** (208) 983-2440

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 261QR0400X | Rehabilitation Clinic/Center | — | NULL | Yes |

## Other

- **Enumeration date:** 03/02/2007
- **Last updated:** 08/22/2020