Organization
PEARL GROUP HOMES
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MS. LISA C BOWMAN M.S. PSYCHOLOGY (PROGRAM DIRECTOR)
(208) 346-7500
Entity
Organization
Contact information
Practice address
1740 E 17TH ST, SUITE A, IDAHO FALLS, ID 83404-6375
(208) 346-7500
(208) 346-7501
Mailing address
1740 E 17TH ST, SUITE A, IDAHO FALLS, ID 83404-6375
(208) 346-7500
(208) 346-7501
Taxonomy
Speciality
Code
Description
License number
State
320900000X
Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
Primary
—
ID
Other
Enumeration date
11/16/2010
Last updated
11/16/2010
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