Organization
ST LUKE'S ELKS CHILDREN'S REHABILITATION
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JOHN WELSH (ELKS PROVIDER ENROLLMENT SPECIALIST)
(208) 489-4635
Entity
Organization
Contact information
Practice address
3525 E LOUISE DR, SUITE 255, MERIDIAN, ID 83642-6302
(208) 489-5099
Mailing address
914 N 18TH ST, BOISE, ID 83702-3317
(434) 825-5091
Taxonomy
Speciality
Code
Description
License number
State
283XC2000X
Children's Rehabilitation Hospital
Primary
OT-963
ID
Other
Enumeration date
08/27/2014
Last updated
08/27/2014
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