Organization
GEM STATE DEVELOPMENTAL CENTER LLC
Active
Organization
GEM STATE DEVELOPMENTAL CENTER LLC
Active
Other names
Syringa Social Services
Organization subpart
No
Provider details
NPI number
Authorized official
MS. LORI JO POOLE LCSW (CEO)
(208) 888-5565
Entity
Organization
Contact information
Practice address
818 NW 15TH ST, MERIDIAN, ID 83642-3724
(208) 888-5566
(208) 888-5578
Mailing address
818 NW 15TH ST, MERIDIAN, ID 83642-3724
(208) 888-5566
(208) 888-5578
Taxonomy
Speciality
Code
Description
License number
State
251C00000X
Developmentally Disabled Services Day Training Agency
3GEM043
ID
251C00000X
Developmentally Disabled Services Day Training Agency
Primary
4GEM014
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
002570900
—
ID
05
—
002571100
—
ID
05
—
806276000
—
ID
05
—
806782800
—
ID
Enumeration date
02/09/2007
Last updated
10/22/2019
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