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Organization

HUMAN SUPPORTS OF IDAHO, INC.

Active
Organization subpart
No

Provider details

NPI number
Authorized official
GREGORY L DICKERSON LMSW (ADMINISTRATOR)
(208) 321-0160
Entity
Organization

Contact information

Practice address
314 BADIOLA ST, CALDWELL, ID 83605-4389
(208) 454-8389
(208) 454-8404
Mailing address
PO BOX 820, CALDWELL, ID 83606-0820
(208) 454-8389
(208) 454-8404

Taxonomy

Speciality
Code
Description
License number
State
251S00000X
Community/Behavioral Health Agency
Primary

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
002800100
ID
Enumeration date
02/14/2007
Last updated
09/30/2013
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