Organization
STATE OF IDAHO
Active
Other names
SWITC-Kyler House
Organization subpart
No
Provider details
NPI number
Authorized official
SUSAN BROETJE (ADMINISTRATOR)
(208) 697-0625
Entity
Organization
Contact information
Practice address
1182 WEST KYLER AVE, HAYDEN, ID 83835
(208) 762-0244
(208) 762-0269
Mailing address
1660 11TH AVE N, NAMPA, ID 83687-5000
(208) 442-2812
(208) 467-5978
Taxonomy
Speciality
Code
Description
License number
State
315P00000X
Intellectual Disabilities Intermediate Care Facility
Primary
81
ID
Other
Enumeration date
10/17/2012
Last updated
10/17/2012
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