Organization
STATE OF IDAHO DEPARTMENT OF HEALTH AND WELFARE
Active
Other names
State Hospital South
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. TRACEY G. SESSIONS (HOSPITAL ADMINISTRATOR)
(208) 785-8402
Entity
Organization
Contact information
Practice address
700 EAST ALICE, BOX 400, BLACKFOOT, ID 83221
(208) 785-1200
(208) 785-8518
Mailing address
700 E ALICE ST, PO BOX 400, BLACKFOOT, ID 83221-4925
(208) 785-1200
(208) 785-8518
Taxonomy
Speciality
Code
Description
License number
State
283Q00000X
Psychiatric Hospital
Primary
#17
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
002821500
—
ID
01
—
00844
BLUE CROSS OF IDAHO
ID
01
—
20315
REGENCE BLUE SHIELD OF ID
ID
Enumeration date
12/01/2005
Last updated
05/08/2013
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