East Idaho Youth Homes LLC Dda

NPI #1316648546 in Ammon, Idaho

Provider Information

NPI Number: 1316648546
Entity Type: Organization
Organization Name: East Idaho Youth Homes LLC Dda
Subpart: Yes (part of a larger organization)
Parent Organization: EAST IDAHO YOUTH HOMES LLC
Primary Specialty: Clinic/Center - Developmental Disabilities
Enumeration Date: Mar 14, 2023
Last Updated: Mar 14, 2023

Practice Location

Address: 983 CURLEW DR
City: Ammon
State: Idaho
ZIP Code: 83406-4706
Phone: (208) 881-9100

Authorized Official

Name: KAREN FAYE TORNKVIST
Title: CHIEF ADMINISTRATOR
Phone: (208) 360-8102

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Behavior Analyst	103K00000X
Assistant Behavior Analyst	106E00000X
Behavior Technician	106S00000X
Clinic/Center - Developmental Disabilities — Developmental Disabilities	261QD1600X	Primary

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