# IDAHO DEPT OF HEALTH & WELFARE REG 6 CMH BF C

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

## Provider details

- **NPI number:** 1710019476
- **Authorized official:** ED AXFORD (PROGRAM MANAGER)
- **Authorized official phone:** (208) 234-7900

## Contact information

- **Practice address:** 701 E ALICE, BLACKFOOT, ID 83221-0129
- **Practice address phone:** (208) 785-5826
- **Practice address fax:** (208) 785-1003
- **Mailing address:** PO BOX 129, BLACKFOOT, ID 83221-0129
- **Mailing address phone:** (208) 785-5826
- **Mailing address fax:** (208) 785-1003

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 261QM0855X | Adolescent and Children Mental Health Clinic/Center | — | NULL | Yes |

## Other

- **Enumeration date:** 03/09/2007
- **Last updated:** 08/22/2020