Organization
IDAHO FALLS GROUP HOMES
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. REX REDDEN (ADMINISTRATOR)
(208) 523-0053
Entity
Organization
Contact information
Practice address
4360 WANDA ST, AMMON, ID 83406-6878
(208) 522-4614
Mailing address
PO BOX 50457, IDAHO FALLS, ID 83405-0457
Taxonomy
Speciality
Code
Description
License number
State
315P00000X
Intellectual Disabilities Intermediate Care Facility
Primary
29
ID
Other
Enumeration date
06/12/2007
Last updated
08/22/2020
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