Provider Demographics
NPI:1235253808
Name:NORTHFORK DEVELOPMENTAL SERVICES INC.
Entity Type:Organization
Organization Name:NORTHFORK DEVELOPMENTAL SERVICES INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:R
Authorized Official - Last Name:PARKE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:208-624-7781
Mailing Address - Street 1:PO BOX 532
Mailing Address - Street 2:
Mailing Address - City:SAINT ANTHONY
Mailing Address - State:ID
Mailing Address - Zip Code:83445
Mailing Address - Country:US
Mailing Address - Phone:208-624-7781
Mailing Address - Fax:208-624-7742
Practice Address - Street 1:104 N BRIDGE ST
Practice Address - Street 2:SUITE #117
Practice Address - City:SAINT ANTHONY
Practice Address - State:ID
Practice Address - Zip Code:83445
Practice Address - Country:US
Practice Address - Phone:208-624-7781
Practice Address - Fax:208-624-7742
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-19
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ID7NRTHF030251C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251C00000XAgenciesDay Training, Developmentally Disabled Services