Idaho Dept of Health & Welfare Region 7 CMH PSR Rexburg
Organization
Active NPI
Rehabilitation Clinic/Center · Rexburg, ID
NPI 1508992926 · NPPES record last updated Aug 22, 2020
Key facts
- NPI
- 1508992926
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Rehabilitation Clinic/Center 261QR0400X
- Legal business name
- IDAHO DEPT OF HEALTH & WELFARE REGION 7 CMH PSR REXBURG
- Practice address
- 333 Walker Dr
Rexburg, ID 83440-1657
- Phone
- (208) 359-4751
- Fax
- (208) 359-5461
- NPI assigned
- Feb 27, 2007
- Organization subpart
- No
Authorized official
- Name
- Mrs. Melissa M Bean, MA
- Title
- Program Manger
- Phone
- (208) 528-5706
Corporate family (same tax ID) 24
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National Provider Directory
- Tax ID family
- Reg VI Mental Health Ctr (114 organizations share this tax ID)
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|
| Rehabilitation Clinic/Center |
261QR0400X |
|
|
Yes |
Addresses
Primary practice location
333 Walker Dr
Rexburg, ID 83440-1657
Mailing address
333 Walker Dr
Rexburg, ID 83440-1657
Phone (208) 359-4751
Other identifiers
| Identifier | Type | State | Issuer |
|---|
| 000010019677 | Other | | BLUE SHIELD |
| 8073802 | Medicaid | ID | |
| HW157 | Other | | BLUE CROSS OF IDAHO |