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228 Shoup Ave W Twin Falls ID 83301-5022 | |
| (208) 734-6760 | |
| Not Available |
| Full Name | |
|---|---|
| Speciality | Psychiatric Unit |
| Location | 228 Shoup Ave W, Twin Falls, Idaho |
| Authorized Official Name and Position | Kathryn Fowler (SENIOR VP, CFO) |
| Authorized Official Contact | 2083818717 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
Po Box 2777 Boise ID 83701-2777 Ph: (208) 706-5000 | 228 Shoup Ave W Twin Falls ID 83301-5022 Ph: (208) 734-6760 |
| NPI Number | 1164469870 |
|---|---|
| Provider Enumeration Date | 06/01/2006 |
| Last Update Date | 06/29/2023 |
| Certification Date | 06/29/2023 |
| Medicare PECOS PAC ID | 4880606326 |
|---|---|
| Medicare Enrollment ID | O20070716000195 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1164469870 | NPI | - | NPPES |
| 100505262 | Other | ID | NEVADA MEDICAID INPT PROV |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 273R00000X | Psychiatric Unit | (* (Not Available)) | Primary |
| 283Q00000X | Psychiatric Hospital | (* (Not Available)) | Secondary |
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