# ST LUKE'S ELKS CHILDREN'S REHABILITATION

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

## Provider details

- **NPI number:** 1457751471
- **Authorized official:** JOHN WELSH (ELKS PROVIDER ENROLLMENT SPECIALIST)
- **Authorized official phone:** (208) 489-4635

## Contact information

- **Practice address:** 3525 E LOUISE DR, SUITE 255, MERIDIAN, ID 83642-6302
- **Practice address phone:** (208) 489-5099
- **Mailing address:** 914 N 18TH ST, BOISE, ID 83702-3317
- **Mailing address phone:** (434) 825-5091

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 283XC2000X | Children's Rehabilitation Hospital | OT-963 | ID | Yes |

## Other

- **Enumeration date:** 08/27/2014
- **Last updated:** 08/27/2014