Provider Demographics
NPI:1407180300
Name:CENTER CASE MANAGEMENT AND DD SERVICES LLC
Entity Type:Organization
Organization Name:CENTER CASE MANAGEMENT AND DD SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:LEEANN
Authorized Official - Middle Name:A
Authorized Official - Last Name:TURPIN
Authorized Official - Suffix:
Authorized Official - Credentials:LCPC
Authorized Official - Phone:208-237-3880
Mailing Address - Street 1:4460 CENTRAL WAY
Mailing Address - Street 2:SUITE 4
Mailing Address - City:CHUBBUCK
Mailing Address - State:ID
Mailing Address - Zip Code:83202-5095
Mailing Address - Country:US
Mailing Address - Phone:208-237-3880
Mailing Address - Fax:208-237-9844
Practice Address - Street 1:4460 CENTRAL WAY
Practice Address - Street 2:SUITE 4
Practice Address - City:CHUBBUCK
Practice Address - State:ID
Practice Address - Zip Code:83202-5095
Practice Address - Country:US
Practice Address - Phone:208-237-3880
Practice Address - Fax:208-237-9844
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-09-24
Last Update Date:2009-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes302R00000XManaged Care OrganizationsHealth Maintenance Organization