# IDAHO DEPT OF HEALTH & WELFARE REG II CMH MOSCOW

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

## Provider details

- **NPI number:** 1720116551
- **Authorized official:** VICKI R. MALONE MSW (PROGRAM MANAGER)
- **Authorized official phone:** (208) 799-4440

## Contact information

- **Practice address:** 1350 TROY HWY, MOSCOW, ID 83543-3995
- **Practice address phone:** (208) 882-0562
- **Practice address fax:** (208) 882-8575
- **Mailing address:** 1350 TROY HWY, MOSCOW, ID 83543-3995
- **Mailing address phone:** (208) 882-0562
- **Mailing address fax:** (208) 882-8575

## Taxonomy

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

## Other

- **Enumeration date:** 03/01/2007
- **Last updated:** 08/22/2020