Organization
CANYON CREEK DEVELOPMENTAL SERVICES
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. BETH A MOODY (CFO)
(208) 454-6266
Entity
Organization
Contact information
Practice address
5214 CLEVELAND BLVD STE G, CALDWELL, ID 83607-8713
(208) 454-6266
(208) 454-6263
Mailing address
5214 CLEVELAND BLVD STE G, CALDWELL, ID 83607-8713
(208) 454-6266
(208) 454-6263
Taxonomy
Speciality
Code
Description
License number
State
251C00000X
Developmentally Disabled Services Day Training Agency
Primary
3CANCRK123
ID
Other
Enumeration date
12/20/2006
Last updated
08/22/2020
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