# IDAHO DEPT OF HEALTH & WELFARE REG 7 CMH P C

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

## Provider details

- **NPI number:** 1639201593
- **Authorized official:** RANDY RODRIQUEZ LCSW (PROGRAM MANAGER)
- **Authorized official phone:** (208) 528-5700

## Contact information

- **Practice address:** 720 E ALICE, BLACKFOOT, ID 83221-0129
- **Practice address phone:** (208) 785-5871
- **Practice address fax:** (208) 785-5877
- **Mailing address:** 720 E ALICE PO BOX 129, BLACKFOOT, ID 83221-0129
- **Mailing address phone:** (208) 785-5871
- **Mailing address fax:** (208) 785-5877

## Taxonomy

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

## Other

- **Enumeration date:** 03/09/2007
- **Last updated:** 08/10/2010