Organization
IDAHO DEPT OF HEALTH & WELFARE
Active
Parent organization
IDAHO DEPT OF HEALTH & WELFARE
Organization subpart
Yes
Provider details
NPI number
Legal business name
IDAHO DEPT OF HEALTH & WELFARE
Authorized official
SCOTT RASMUSSEN LCSW (HUMAN SERVICES FIELD PROGRAM MANAGE)
(208) 732-1601
Entity
Organization
Contact information
Practice address
2241 OVERLAND AVE, BURLEY, ID 83318-2929
(208) 677-5390
(208) 677-4002
Mailing address
2241 OVERLAND AVE, BURLEY, ID 83318-2929
(208) 677-5390
(208) 677-4002
Taxonomy
Speciality
Code
Description
License number
State
251S00000X
Community/Behavioral Health Agency
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000010025422
BLUE SHIELD
ID
05
—
8073415
—
ID
01
—
HW140
BLUE CROSS
ID
Enumeration date
03/08/2007
Last updated
01/09/2019
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