Organization
PINNACLE HEALTH SYSTEMS
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DONEVAN B NEIDER LCSW (OWNER)
(208) 552-0920
Entity
Organization
Contact information
Practice address
1522 ELK CREEK DRIVE, IDAHO FALLS, ID 83404
(208) 552-0920
(208) 529-2564
Mailing address
1522 ELK CREEK DRIVE, IDAHO FALLS, ID 83404
(208) 552-0920
(208) 529-2564
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
—
—
2084P0800X
Psychiatry Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
807134000
—
ID
Enumeration date
06/15/2006
Last updated
05/06/2009
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