Organization
THE IDAHO CHILDREN'S REHABILITATION CENTER
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. MATT F SMITH (MANAGER)
(208) 529-4300
Entity
Organization
Contact information
Practice address
1975 MARTHA AVENUE, IDAHO FALLS, ID 83404-7533
(208) 529-4300
(208) 529-1627
Mailing address
1975 MARTHA AVENUE, IDAHO FALLS, ID 83404-7533
(208) 529-4300
(208) 529-1627
Taxonomy
Speciality
Code
Description
License number
State
251S00000X
Community/Behavioral Health Agency
Primary
—
—
Other
Enumeration date
04/02/2008
Last updated
06/24/2008
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