Organization
49 ALPHA A
Active
Organization subpart
No
Provider details
NPI number
Authorized official
GLEN THORNE (PRESIDENT)
(208) 308-0158
Entity
Organization
Contact information
Practice address
1035 N LINCOLN AVE, JEROME, ID 83338-1816
(208) 308-0158
Mailing address
1102 KENYON RD, TWIN FALLS, ID 83301-5648
(208) 751-3013
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
—
—
261QR0405X
Substance Use Disorder Rehabilitation Clinic/Center
—
—
3245S0500X
Children's Substance Abuse Rehabilitation Facility
Primary
—
—
Other
Enumeration date
04/21/2025
Last updated
09/09/2025
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