Organization
SOUTHEASTERN IDAHO DEVELOPMENTAL CENTER, INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JIM P. MCCOY (OWNER DIRECTOR)
(208) 782-1301
Entity
Organization
Contact information
Practice address
765 W JUDICIAL ST, BLACKFOOT, ID 83221-2036
(208) 782-1301
(208) 782-3627
Mailing address
PO BOX 701, BLACKFOOT, ID 83221-0701
(208) 782-1301
(208) 782-3627
Taxonomy
Speciality
Code
Description
License number
State
251C00000X
Developmentally Disabled Services Day Training Agency
Primary
6SOEAST035
ID
Other
Enumeration date
01/26/2007
Last updated
03/20/2008
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