Organization
ASHTON MEMORIAL INC
Active
Other names
Gustafson House
Organization subpart
No
Provider details
NPI number
Authorized official
SUZANNE BRADY (HR DIRECTOR/COMPLIANCE OFFICER)
(208) 652-7461
Entity
Organization
Contact information
Practice address
2935 ROLLANDET ST, IDAHO FALLS, ID 83402-4654
(208) 542-2905
(208) 522-2427
Mailing address
PO BOX 838, ASHTON, ID 83420-0838
(208) 652-7461
(208) 652-7595
Taxonomy
Speciality
Code
Description
License number
State
322D00000X
Emotionally Disturbed Childrens' Residential Treatment Facility
Primary
—
—
Other
Enumeration date
05/23/2024
Last updated
05/23/2024
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