Organization · NPI-2

Grand Teton Service Group

Residential Treatment Facility, Intellectual and/or Developmental Disabilities · Idaho Falls, ID

NPI number1548496201
StatusActive
Last updated in NPPESJun 8, 2009

Details

NPI
1548496201
Entity type
Organization (NPI-2)
Legal business name
Grand Teton Service Group
Organization subpart
No
Enumeration date
Jun 8, 2009
Last updated
Jun 8, 2009

Taxonomy and licenses

Taxonomy codeDescriptionLicenseStatePrimary
320600000X Residential Treatment Facility, Intellectual and/or Developmental DisabilitiesRHA-313IDYes

Practice location

329 Park Ave
Idaho Falls, ID 83402-3610

Phone 208-528-7443 · Fax 208-528-7321

Mailing address

Po Box 50457
Idaho Falls, ID 83405-0457

Phone 208-528-7443 · Fax 208-528-7321

Authorized official

Lisa Bowman
Program Director
2085287443

Is something wrong?

This page shows exactly what the provider filed with NPPES. Only the provider (or their surrogate) can change it, by signing in to NPPES. Our page updates within a day of their change. See how to update NPI information.

Other Residential Treatment Facility, Intellectual and/or Developmental Disabilities providers in Idaho Falls, ID