Organization
GRAND TETON SERVICE GROUP
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MS. LISA BOWMAN MASTERS/PSYCHOLOGY (PROGRAM DIRECTOR)
(208) 528-7443
Entity
Organization
Contact information
Practice address
329 PARK AVE, IDAHO FALLS, ID 83402-3610
(208) 528-7443
(208) 528-7321
Mailing address
PO BOX 50457, IDAHO FALLS, ID 83405-0457
(208) 528-7443
(208) 528-7321
Taxonomy
Speciality
Code
Description
License number
State
320600000X
Intellectual and/or Developmental Disabilities Residential Treatment Facility
Primary
RHA-313
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0026966
—
ID
Enumeration date
06/08/2009
Last updated
06/08/2009
About Stedi
Stedi is the only programmable healthcare clearinghouse. You can use Stedi's APIs to process eligibility checks, claims, remits, and more.
Contact us