Organization
HUMAN SUPPORTS OF IDAHO, INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
GREGORY LEROY DICKERSON LMSW (ADMINISTRATOR)
(208) 321-0160
Entity
Organization
Contact information
Practice address
314 BADIOLA ST, CALDWELL, ID 83605-4389
(208) 454-8389
(208) 454-8404
Mailing address
PO BOX 820, CALDWELL, ID 83606-0820
(208) 454-8389
(208) 454-8404
Taxonomy
Speciality
Code
Description
License number
State
251S00000X
Community/Behavioral Health Agency
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
807338200
—
ID
Enumeration date
02/14/2007
Last updated
09/30/2013
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