Organization
AHS OF IDAHO
Active
Other names
SUWS Adolescent & Youth Programs
Organization subpart
No
Provider details
NPI number
Authorized official
MS. KATHY REX CRT (EXECUTIVE DIRECTOR)
(208) 886-2565
Entity
Organization
Contact information
Practice address
911 PREACHER CREEK RD, SHOSHONE, ID 83352-5061
(208) 886-2565
(208) 886-2153
Mailing address
911 PREACHER CREEK RD, SHOSHONE, ID 83352-5061
(208) 886-2565
(208) 886-2153
Taxonomy
Speciality
Code
Description
License number
State
322D00000X
Emotionally Disturbed Childrens' Residential Treatment Facility
Primary
25860
ID
Other
Enumeration date
04/02/2009
Last updated
04/02/2009
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