Provider Demographics
NPI:1033231170
Name:DEVELOPMENT WORKSHOP, INC.
Entity Type:Organization
Organization Name:DEVELOPMENT WORKSHOP, INC.
Other - Org Name:UPPER VALLEY INDUSTRIES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:MS
Authorized Official - First Name:JOELLEN
Authorized Official - Middle Name:
Authorized Official - Last Name:JONES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:208-524-1550
Mailing Address - Street 1:555 W 25TH ST
Mailing Address - Street 2:
Mailing Address - City:IDAHO FALLS
Mailing Address - State:ID
Mailing Address - Zip Code:83402-4527
Mailing Address - Country:US
Mailing Address - Phone:208-524-1550
Mailing Address - Fax:208-523-3148
Practice Address - Street 1:16 N 2ND E
Practice Address - Street 2:
Practice Address - City:REXBURG
Practice Address - State:ID
Practice Address - Zip Code:83440-1644
Practice Address - Country:US
Practice Address - Phone:208-356-3722
Practice Address - Fax:208-356-3773
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-06
Last Update Date:2008-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ID0023966251C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251C00000XAgenciesDay Training, Developmentally Disabled Services
Provider Identifiers
StateIdentifier IDID TypeIssuer
ID0023966Medicaid