Idaho Dept Of Health & Welfare Reg 6 Cmh Bf C
Clinic/Center, Adolescent and Children Mental Health in Blackfoot, ID. Organization (NPI-2).
NPI number1710019476
StatusActive
Last updated in NPPESAug 22, 2020
Details
- NPI
- 1710019476
- Entity type
- Organization (NPI-2)
- Legal business name
- Idaho Dept Of Health & Welfare Reg 6 Cmh Bf C
- Organization subpart
- No
- Enumeration date
- Mar 9, 2007
- Last updated
- Aug 22, 2020
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 261QM0855X | Clinic/Center, Adolescent and Children Mental Health | – | – | Yes |
Practice location
701 E AliceBlackfoot, ID 83221-0129
Phone 208-785-5826 · Fax 208-785-1003
Mailing address
Po Box 129Blackfoot, ID 83221-0129
Phone 208-785-5826 · Fax 208-785-1003
Authorized official
Ed Axford
Program Manager
2082347900
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