Organization
ADOLESCENT & CHILD DEVELOPMENT CENTER, LLC
Active
Organization
ADOLESCENT & CHILD DEVELOPMENT CENTER, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. VANCE RAY WALKER (OWNER/EXECUTIVE DIRECTOR)
(208) 232-5622
Entity
Organization
Contact information
Practice address
151 N 3RD AVE, SUITE 110, POCATELLO, ID 83201-6331
(208) 232-5622
(208) 233-4639
Mailing address
151 N 3RD AVE, SUITE 110, POCATELLO, ID 83201-6331
(208) 232-5622
(208) 233-4639
Taxonomy
Speciality
Code
Description
License number
State
261QD1600X
Developmental Disabilities Clinic/Center
Primary
261QD1600X
ID
261QM0801X
Mental Health Clinic/Center (Including Community Mental Health Center)
261QM0801X
ID
261QM0850X
Adult Mental Health Clinic/Center
261QM0850X
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
808028200
—
ID
05
—
808257100
—
ID
05
—
808259000
—
ID
Enumeration date
06/02/2008
Last updated
04/02/2009
Update your record
If you believe information in your NPPES record is inaccurate, or if you wish to update or deactivate your NPI, you can do so directly with CMS at https://nppes.cms.hhs.gov.
About Stedi
Stedi is the only programmable healthcare clearinghouse. You can use Stedi's APIs to process eligibility checks, claims, remits, and more.
Sign up