| Mountain River Mental Health | |
|
3767 Professional Way Idaho Falls ID 83402-7315 | |
| (208) 522-8899 | |
| (208) 522-6596 |
| Full Name | Mountain River Mental Health |
|---|---|
| Speciality | Social Worker |
| Location | 3767 Professional Way, Idaho Falls, Idaho |
| Authorized Official Name and Position | Bruce Hampton (PRESIDENT SOCIAL WORKER) |
| Authorized Official Contact | 2085228899 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Mountain River Mental Health Po Box 2106 Idaho Falls ID 83403-2106 Ph: (208) 522-8899 | Mountain River Mental Health 3767 Professional Way Idaho Falls ID 83402-7315 Ph: (208) 522-8899 |
| NPI Number | 1447382973 |
|---|---|
| Provider Enumeration Date | 03/11/2007 |
| Last Update Date | 05/21/2008 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1447382973 | NPI | - | NPPES |
| 806612700 | Medicaid | ID |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 104100000X | Social Worker | (* (Not Available)) | Primary |
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