Organization
MOUNTAIN STATES GROUP, INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. HARTZELL COBBS REL.D. (EXECUTIVE DIRECTOR)
(208) 336-5533
Entity
Organization
Contact information
Practice address
1607 W JEFFERSON ST, BOISE, ID 83702-5111
(208) 336-5533
(208) 947-4290
Mailing address
1607 W JEFFERSON ST, BOISE, ID 83702-5111
(208) 336-5533
(208) 947-4290
Taxonomy
Speciality
Code
Description
License number
State
251S00000X
Community/Behavioral Health Agency
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000010144428
REGENCEBLUESHIELDCLINIC
ID
01
—
8H237
MENTAL HEALTH CLINIC BCI
ID
Enumeration date
01/25/2007
Last updated
08/22/2020
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