Southeastern Idaho Developmental Center, Inc.

NPI #1558535948 in Blackfoot, Idaho

Provider Information

NPI Number
1558535948
Entity Type
Organization
Organization Name
Southeastern Idaho Developmental Center, Inc.
Primary Specialty
Case Management
Enumeration Date
Apr 16, 2008
Last Updated
Apr 16, 2008

Practice Location

Address
765 W JUDICIAL ST
State
Idaho
ZIP Code
83221-2036
Phone
(208) 782-1301

Authorized Official

Name
JIM P. MCCOY
Title
OWNER DIRECTOR
Phone
(208) 782-1301

Specialties & Taxonomy Codes

Specialty
Case Management

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