Provider Demographics
NPI:1518356906
Name:IDAHO FAMILY SERVICES
Entity Type:Organization
Organization Name:IDAHO FAMILY SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:TANYA
Authorized Official - Middle Name:
Authorized Official - Last Name:WHITE
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:208-436-3800
Mailing Address - Street 1:818 S ONEIDA ST
Mailing Address - Street 2:
Mailing Address - City:RUPERT
Mailing Address - State:ID
Mailing Address - Zip Code:83350-2071
Mailing Address - Country:US
Mailing Address - Phone:208-436-3800
Mailing Address - Fax:208-436-3801
Practice Address - Street 1:818 S ONEIDA ST
Practice Address - Street 2:SUITE #4
Practice Address - City:RUPERT
Practice Address - State:ID
Practice Address - Zip Code:83350-2071
Practice Address - Country:US
Practice Address - Phone:208-436-3800
Practice Address - Fax:208-436-3801
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-01-22
Last Update Date:2015-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDLCSW 325071041C0700X, 251B00000X, 253J00000X
251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes251S00000XAgenciesCommunity/Behavioral HealthGroup - Multi-Specialty
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty
No251B00000XAgenciesCase Management
No253J00000XAgenciesFoster Care Agency