| Easterseals-goodwill Northern Rocky Mountain, Inc. | |
|
1465 S Vinnell Way Boise ID 83709-1659 | |
| (208) 378-9924 | |
| (208) 378-9965 |
| Full Name | Easterseals-goodwill Northern Rocky Mountain, Inc. |
|---|---|
| Speciality | Community/behavioral Health |
| Location | 1465 S Vinnell Way, Boise, Idaho |
| Authorized Official Name and Position | Mark Sherman (CFO) |
| Authorized Official Contact | 4067713762 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Easterseals-goodwill Northern Rocky Mountain, Inc. 425 1st Ave N Great Falls MT 59401-2507 Ph: (406) 761-3680 | Easterseals-goodwill Northern Rocky Mountain, Inc. 1465 S Vinnell Way Boise ID 83709-1659 Ph: (208) 378-9924 |
| NPI Number | 1730204116 |
|---|---|
| Provider Enumeration Date | 03/21/2007 |
| Last Update Date | 03/26/2019 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1730204116 | NPI | - | NPPES |
| 80636100 | Medicaid | ID | |
| 806648000 | Medicaid | ID | |
| 806361001 | Medicaid | ID |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 251S00000X | Community/behavioral Health | (* (Not Available)) | Primary |
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