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Organization

SNAKE RIVER COMMUNITY SUPPORTED LIVING

Active
Organization subpart
No

Provider details

NPI number
Authorized official
KATHLEEN ANN HANSEN (OWNER/ADMINISTRATOR)
(208) 542-4517
Entity
Organization

Contact information

Practice address
557 S WOODRUFF AVE, IDAHO FALLS, ID 83401-5200
(208) 542-4517
Mailing address
557 S WOODRUFF AVE, IDAHO FALLS, ID 83401-5200
(208) 542-4517

Taxonomy

Speciality
Code
Description
License number
State
251S00000X
Community/Behavioral Health Agency
Primary

Other

Enumeration date
06/30/2014
Last updated
06/30/2014
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  • EDI platform