Idaho Dept of Health & Welfare Reg 7 CMH P C
Organization Active NPI Rehabilitation Clinic/Center · Blackfoot, ID
NPI 1639201593 · NPPES record last updated Aug 10, 2010
Key facts
- NPI
- 1639201593
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Rehabilitation Clinic/Center 261QR0400X
- Legal business name
- IDAHO DEPT OF HEALTH & WELFARE REG 7 CMH P C
- Practice address
- 720 E Alice
Blackfoot, ID 83221-0129 - Phone
- (208) 785-5871
- Fax
- (208) 785-5877
- NPI assigned
- Mar 9, 2007
- Organization subpart
- No
Authorized official
- Name
- Randy Rodriquez, LCSW
- Title
- Program Manager
- Phone
- (208) 528-5700
Corporate family (same tax ID) 24
Practitioners 5
-
Josie Adkins, LCPC
-
Jennifer Joy Awiah, LCSW
-
Susan Doran, LSW
-
Casandra Dayley Serr, LSW
National Provider Directory
- Tax ID family
- Reg VI Mental Health Ctr
Locations
720 E Alice
Blackfoot, ID 83221
Phone (208) 785-5871
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Rehabilitation Clinic/Center | 261QR0400X | Yes |
Addresses
Primary practice location
720 E Alice
Blackfoot, ID 83221-0129
Mailing address
720 E Alice PO Box 129
Blackfoot, ID 83221-0129
Phone (208) 785-5871
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 000010019677 | Other | ID | BLUE SHIELD |
| 8073649 | Medicaid | ID | |
| HW157 | Other | ID | BLUE CROSS |
Other providers in Blackfoot, ID
- Hyde Physical Therapy
- Jason Ray Hyde
- Tresa Hyde
- Idaho Dept of Health & Welfare Reg 6 CMH BF C
- Idaho Dept of Health & Welfare Reg 7 Amh BF
- Idaho Express Transportation LLC
- Idaho Kidney Center-Blackfoot LLC
- Idaho Pathology Laboratory
- Idaho Physicians Clinic
- Idaho Science & Technology Charter School
All providers in Blackfoot, ID · Rehabilitation Clinic/Center in Idaho
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Aug 10, 2010. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.