# IDAHO DEPT OF HEALTH &WELFARE REG 6 CMH PSR P

> Is this information incorrect? This page shows public data from NPPES. Update your record in NPPES and this page will update automatically within 7 days. [Update your NPPES record](https://nppes.cms.hhs.gov)

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

## Provider details

- **NPI number:** 1497887871
- **Authorized official:** RITCHIE WEERS (CLINICAL SUPERVISOR)
- **Authorized official phone:** (208) 234-7900

## Contact information

- **Practice address:** 421 MEMORIAL DR, POCATELLO, ID 83201-4008
- **Practice address phone:** (208) 234-7900
- **Practice address fax:** (208) 236-6328
- **Mailing address:** 421 MEMORIAL DR, POCATELLO, ID 83201-4008
- **Mailing address phone:** (208) 234-7900
- **Mailing address fax:** (208) 236-6328

## Taxonomy

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

## Other

- **Enumeration date:** 03/12/2007
- **Last updated:** 10/22/2010