Organization
IDAHO CENTER FOR AUTISM, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MS. STEPHANIE M SPENCER WHIPPS M.S. (EXECUTIVE DIRECTOR)
(208) 342-0374
Entity
Organization
Contact information
Practice address
200 S PHILLIPPI ST, BOISE, ID 83705-1152
(208) 342-0374
(208) 331-2017
Mailing address
PO BOX 706, MERIDIAN, ID 83680-0706
(208) 342-0374
(208) 331-2017
Taxonomy
Speciality
Code
Description
License number
State
251C00000X
Developmentally Disabled Services Day Training Agency
3CFA146
ID
251C00000X
Developmentally Disabled Services Day Training Agency
Primary
4CFA144
ID
Other
Enumeration date
02/23/2007
Last updated
08/22/2020
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