Organization
ALL DEVELOPMENTAL DISABILITY SERVICES
Active
Organization
ALL DEVELOPMENTAL DISABILITY SERVICES
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MS. MICHELLE A MITTON B.S. (PROGRAM ADMINISTRATOR)
(208) 465-5114
Entity
Organization
Contact information
Practice address
1350 S VISTA AVE, BOISE, ID 83705-2567
(208) 424-3160
(208) 433-9794
Mailing address
2717 S KIMBALL AVE, CALDWELL, ID 83605-5623
(208) 465-5114
(208) 465-5198
Taxonomy
Speciality
Code
Description
License number
State
261QD1600X
Developmental Disabilities Clinic/Center
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
808063100
—
ID
05
—
808063101
—
ID
05
—
808065600
—
ID
05
—
808065601
—
ID
05
—
808077800
—
ID
05
—
808077801
—
ID
05
—
808317200
—
ID
Enumeration date
06/26/2008
Last updated
06/18/2009
Update your record
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