Organization
ST. LUKE'S ELKS CHILDRENS REHAB
Active
Organization subpart
No
Provider details
NPI number
Authorized official
BRENT WILSON (COMPLIANCE AND RISK MANAGEMENT)
(208) 489-4761
Entity
Organization
Contact information
Practice address
405 W MYRTLE ST, BOISE, ID 83702-7658
(208) 489-5880
Mailing address
405 W MYRTLE ST, BOISE, ID 83702-7658
Taxonomy
Speciality
Code
Description
License number
State
283XC2000X
Children's Rehabilitation Hospital
Primary
SLP-2340
ID
Other
Enumeration date
09/30/2013
Last updated
09/30/2013
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