| Mountain Home | |
|
2850 Industrial Way Mountain Home ID 83647-3960 | |
| (208) 587-2679 | |
| Not Available |
| Full Name | Mountain Home |
|---|---|
| Speciality | Clinic/center - Adolescent And Children Mental Health |
| Location | 2850 Industrial Way, Mountain Home, Idaho |
| Authorized Official Name and Position | Chris Banken (SR. VICE PRSIDENT OF OPERATIONS) |
| Authorized Official Contact | 6023352095 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Mountain Home 2850 Industrial Way Mountain Home ID 83647-3960 Ph: () - | Mountain Home 2850 Industrial Way Mountain Home ID 83647-3960 Ph: (208) 587-2679 |
| NPI Number | 1891047296 |
|---|---|
| Provider Enumeration Date | 10/09/2012 |
| Last Update Date | 10/09/2012 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1891047296 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QM0855X | Clinic/center - Adolescent And Children Mental Health | (* (Not Available)) | Primary |
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