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Organization
ST LUKE'S ELKS CHILDREN'S REHABILITATION
Active
Organization
ST LUKE'S ELKS CHILDREN'S REHABILITATION
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JOHN WELSH (ELKS PROVIDER ENROLLMENT SPECIALIST)
(208) 489-4635
Entity
Organization
Contact information
Practice address
3525 E LOUISE DR, SUITE 255, MERIDIAN, ID 83642-6302
(208) 489-5099
Mailing address
914 N 18TH ST, BOISE, ID 83702-3317
(434) 825-5091
Taxonomy
Speciality
Code
Description
License number
State
283XC2000X
Children's Rehabilitation Hospital
Primary
OT-963
ID
Other
Enumeration date
08/27/2014
Last updated
08/27/2014
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