Provider Demographics
NPI:1417199456
Name:CHERRY GULCH
Entity Type:Organization
Organization Name:CHERRY GULCH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FOUNDER & PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ANDREW
Authorized Official - Middle Name:DEAN
Authorized Official - Last Name:SAPP
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:208-365-3437
Mailing Address - Street 1:PO BOX 678
Mailing Address - Street 2:
Mailing Address - City:EMMETT
Mailing Address - State:ID
Mailing Address - Zip Code:83617-0678
Mailing Address - Country:US
Mailing Address - Phone:208-365-3437
Mailing Address - Fax:208-365-7235
Practice Address - Street 1:3770 E. BLACK CANYON HWY
Practice Address - Street 2:
Practice Address - City:EMMETT
Practice Address - State:ID
Practice Address - Zip Code:83617-0678
Practice Address - Country:US
Practice Address - Phone:208-365-3437
Practice Address - Fax:208-365-7235
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-04-06
Last Update Date:2009-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ID24454323P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes323P00000XResidential Treatment FacilitiesPsychiatric Residential Treatment Facility