Provider Demographics
NPI:1346468006
Name:A REFERRAL & INFORMATION SERVICE
Entity Type:Organization
Organization Name:A REFERRAL & INFORMATION SERVICE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MISS
Authorized Official - First Name:BRENDA
Authorized Official - Middle Name:ELAINE
Authorized Official - Last Name:DEGNER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:208-733-0443
Mailing Address - Street 1:1537 ADDISON AVE E
Mailing Address - Street 2:
Mailing Address - City:TWIN FALLS
Mailing Address - State:ID
Mailing Address - Zip Code:83301-5342
Mailing Address - Country:US
Mailing Address - Phone:208-733-0443
Mailing Address - Fax:208-735-1375
Practice Address - Street 1:1537 ADDISON AVE E
Practice Address - Street 2:
Practice Address - City:TWIN FALLS
Practice Address - State:ID
Practice Address - Zip Code:83301-5342
Practice Address - Country:US
Practice Address - Phone:208-733-0443
Practice Address - Fax:208-735-1375
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-20
Last Update Date:2008-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management
Provider Identifiers
StateIdentifier IDID TypeIssuer
ID807675400Medicaid
ID807669900Medicaid