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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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