| Easterseals-goodwill Northern Rocky Mountain, Inc. | |
|
1607 N Parkcentre Pl Nampa ID 83651-1705 | |
| (208) 461-8470 | |
| Not Available |
| Full Name | Easterseals-goodwill Northern Rocky Mountain, Inc. |
|---|---|
| Speciality | Community/behavioral Health |
| Location | 1607 N Parkcentre Pl, Nampa, 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. 1607 N Parkcentre Pl Nampa ID 83651-1705 Ph: (208) 461-8470 |
| NPI Number | 1558486951 |
|---|---|
| Provider Enumeration Date | 03/21/2007 |
| Last Update Date | 03/26/2019 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1558486951 | NPI | - | NPPES |
| 807363600 | Medicaid | ID | |
| 807383100 | Medicaid | ID |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 251S00000X | Community/behavioral Health | (* (Not Available)) | Primary |
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