Organization
TETON SUPPORTED LIVING LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JODI L COPELAND BSW (OWNER/ADMINISTRATOR)
(208) 377-0580
Entity
Organization
Contact information
Practice address
4101 N CRESWELL WAY, BOISE, ID 83713-2404
(208) 377-0580
(208) 672-1388
Mailing address
4101 N CRESWELL WAY, BOISE, ID 83713-2404
(208) 377-0580
(208) 672-1388
Taxonomy
Speciality
Code
Description
License number
State
251C00000X
Developmentally Disabled Services Day Training Agency
Primary
—
—
Other
Enumeration date
04/10/2017
Last updated
04/10/2017
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