Provider Demographics
NPI:1558482711
Name:C AND R INCORPORATION
Entity Type:Organization
Organization Name:C AND R INCORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:VALERIE
Authorized Official - Middle Name:SUE
Authorized Official - Last Name:CUTSHALL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:208-882-8040
Mailing Address - Street 1:1107 S LOGAN ST
Mailing Address - Street 2:
Mailing Address - City:MOSCOW
Mailing Address - State:ID
Mailing Address - Zip Code:83843-3124
Mailing Address - Country:US
Mailing Address - Phone:208-882-8040
Mailing Address - Fax:208-882-9050
Practice Address - Street 1:1107 S LOGAN ST
Practice Address - Street 2:
Practice Address - City:MOSCOW
Practice Address - State:ID
Practice Address - Zip Code:83843-3124
Practice Address - Country:US
Practice Address - Phone:208-882-8040
Practice Address - Fax:208-882-9050
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-03
Last Update Date:2008-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ID8070463251C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251C00000XAgenciesDay Training, Developmentally Disabled Services
Provider Identifiers
StateIdentifier IDID TypeIssuer
ID8070463Medicaid
ID8071281Medicaid