Provider Demographics
NPI:1609092519
Name:DEVELOPMENT WORKSHOP INC
Entity Type:Organization
Organization Name:DEVELOPMENT WORKSHOP INC
Other - Org Name:SALMON RIVER INDUSTRIES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VP REHABILITATION
Authorized Official - Prefix:MS
Authorized Official - First Name:LORI
Authorized Official - Middle Name:
Authorized Official - Last Name:GENTILLON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:208-524-1550
Mailing Address - Street 1:PO BOX 1232
Mailing Address - Street 2:
Mailing Address - City:SALMON
Mailing Address - State:ID
Mailing Address - Zip Code:83467-1232
Mailing Address - Country:US
Mailing Address - Phone:208-756-4608
Mailing Address - Fax:208-756-8998
Practice Address - Street 1:1 AIRPORT PLAZA
Practice Address - Street 2:
Practice Address - City:SALMON
Practice Address - State:ID
Practice Address - Zip Code:83467-1232
Practice Address - Country:US
Practice Address - Phone:208-756-4608
Practice Address - Fax:208-156-8998
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-18
Last Update Date:2012-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ID02396601251C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251C00000XAgenciesDay Training, Developmentally Disabled Services
Provider Identifiers
StateIdentifier IDID TypeIssuer
ID02396601Medicaid