Provider Demographics
NPI:1194365254
Name:BEHAVIORAL ENHANCEMENT SERVICES AND TREATMENT LLC
Entity Type:Organization
Organization Name:BEHAVIORAL ENHANCEMENT SERVICES AND TREATMENT LLC
Other - Org Name:SOUTH EAST IDAHO BEHAVIORAL CRISIS CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:BILLING DEPARTMENT DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:DEMI
Authorized Official - Middle Name:
Authorized Official - Last Name:ECHI-ABOLI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:208-360-1038
Mailing Address - Street 1:PO BOX 2106
Mailing Address - Street 2:
Mailing Address - City:IDAHO FALLS
Mailing Address - State:ID
Mailing Address - Zip Code:83403-2106
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1001 N 7TH AVE
Practice Address - Street 2:
Practice Address - City:POCATELLO
Practice Address - State:ID
Practice Address - Zip Code:83201-5761
Practice Address - Country:US
Practice Address - Phone:208-909-5177
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-01-07
Last Update Date:2024-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health