Idaho Dept of Health & Welfare Reg II CMH Orofino
Organization
Active NPI
Rehabilitation Clinic/Center · Orofino, ID
NPI 1699804682 · NPPES record last updated Aug 22, 2020
Key facts
- NPI
- 1699804682
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Rehabilitation Clinic/Center 261QR0400X
- Legal business name
- IDAHO DEPT OF HEALTH & WELFARE REG II CMH OROFINO
- Practice address
- 416 Johnson Ave
Orofino, ID 83544-9516
- Phone
- (208) 476-7703
- Fax
- (208) 476-9516
- NPI assigned
- Mar 5, 2007
- Organization subpart
- No
Authorized official
- Name
- Vicki R. Malone, MSW
- Title
- Program Manager
- Phone
- (208) 799-4440
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
416 Johnson Ave
Orofino, ID 83544-9516
Mailing address
PO Box 712
Orofino, ID 83544-0712
Phone (208) 476-7703
Other identifiers
| Identifier | Type | State | Issuer |
|---|
| HW140 | Other | | BLUE CROSS OF IDAHO |
| 000010018450 | Other | | BLUE SHIELD |
| 8073497 | Medicaid | ID | |