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Organization

IDAHODHWBH3 NAMPA CMH PSR

Active
Organization subpart
No

Provider details

NPI number
Authorized official
MR. TODD L HURT M.S. (FIELD OPERATIONS MANAGER)
(208) 455-7057
Entity
Organization

Contact information

Practice address
823 PARKCENTRE WAY, NAMPA, ID 83651-1783
(208) 465-8452
(208) 465-8431
Mailing address
823 PARKCENTRE WAY, NAMPA, ID 83651-1783
(208) 465-8452
(208) 465-8431

Taxonomy

Speciality
Code
Description
License number
State
261QR0400X
Rehabilitation Clinic/Center
Primary

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
000010018824
BLUESHIELD
05
8073441
ID
01
HW348
BLUE CROSS OF IDAHO
Enumeration date
03/01/2007
Last updated
08/22/2020
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