Organization
NORTH IDAHO COLLEGE
Active
Parent organization
NORTH IDAHO COLLEGE
Other names
Area Agency on Aging of North Idaho
Organization subpart
Yes
Provider details
NPI number
Legal business name
NORTH IDAHO COLLEGE
Authorized official
PEARL BOUCHARD (DIRECTOR)
(208) 667-3179
Entity
Organization
Contact information
Practice address
2120 N LAKEWOOD DR STE B, COEUR D ALENE, ID 83814-2638
(208) 667-3179
(208) 667-5938
Mailing address
2120 N LAKEWOOD DR STE B, COEUR D ALENE, ID 83814-2638
(208) 667-3179
(208) 667-5938
Taxonomy
Speciality
Code
Description
License number
State
171M00000X
Case Manager/Care Coordinator
—
—
171W00000X
Contractor
Primary
—
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
171M00000X
CARE MANAGMENT CARE COORDINATOR
ID
01
—
193200000X
MULTI SPECIALTY
ID
01
—
251B00000X
CASE MANAGEMENT
ID
01
—
251V00000X
VOLUNTARY OR CHARITABLE
ID
Enumeration date
11/30/2012
Last updated
11/30/2012
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