Organization
IDAHO DEPARTMENT OF HEALTH & WELFARE
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. TODD HURT (PROGRAM MANAGER)
(208) 455-7057
Entity
Organization
Contact information
Practice address
3402 FRANKLIN RD, CALDWELL, ID 83605-6932
(208) 459-0092
(208) 454-7714
Mailing address
3402 FRANKLIN RD, CALDWELL, ID 83605-6932
(208) 459-0092
(208) 454-7714
Taxonomy
Speciality
Code
Description
License number
State
261QM0855X
Adolescent and Children Mental Health Clinic/Center
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000010018824
BLUESHIELD
ID
01
—
HW348
BLUE CROSS OF IDAHO
ID
Enumeration date
10/18/2010
Last updated
10/18/2010
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