Organization
EAST IDAHO YOUTH HOMES LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
KAREN FAYE TORNKVIST (CHIEF ADMINISTRATOR)
(208) 360-8102
Entity
Organization
Contact information
Practice address
550 LINDEN DR, IDAHO FALLS, ID 83401-4149
(208) 360-8102
Mailing address
550 LINDEN DR, IDAHO FALLS, ID 83401-4149
(208) 360-8102
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
—
—
251B00000X
Case Management Agency
—
—
320800000X
Mental Illness Community Based Residential Treatment Facility
—
—
320900000X
Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
—
—
Other
Enumeration date
02/10/2023
Last updated
02/10/2023
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