Organization
IDAHO DEPT OF HEALTH & WELFARE REGION 7 CMH PSR REXBURG
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. MELISSA M BEAN MA (PROGRAM MANGER)
(208) 528-5706
Entity
Organization
Contact information
Practice address
333 WALKER DR, REXBURG, ID 83440-1657
(208) 359-4751
(208) 359-5461
Mailing address
333 WALKER DR, REXBURG, ID 83440-1657
(208) 359-4751
(208) 359-5461
Taxonomy
Speciality
Code
Description
License number
State
261QR0400X
Rehabilitation Clinic/Center
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000010019677
BLUE SHIELD
—
05
—
8073802
—
ID
01
—
HW157
BLUE CROSS OF IDAHO
—
Enumeration date
02/27/2007
Last updated
08/22/2020
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