Grand Teton Service Group
NPI #1356577019 in Idaho Falls, Idaho
Provider Information
- NPI Number
- 1356577019
- Entity Type
- Organization
- Organization Name
- Grand Teton Service Group
- Primary Specialty
- Residential Treatment Facility, Intellectual and/or Developmental Disabilities
- Enumeration Date
- Jun 8, 2009
- Last Updated
- Jun 8, 2009
Practice Location
- Address
- 329 PARK AVE
- City
- Idaho Falls
- State
- Idaho
- ZIP Code
- 83402-3610
- Phone
- (208) 528-7443
Authorized Official
- Name
- MS. LISA BOWMAN, MASTERS/PSYCHOLOGY
- Title
- PROGRAM DIRECTOR
- Phone
- (208) 528-7443
Specialties & Taxonomy Codes
| Specialty |
|---|
| Residential Treatment Facility, Intellectual and/or Developmental Disabilities |
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