Provider Demographics
NPI:1629484720
Name:IDAHO COMMISSION ON AGING
Entity Type:Organization
Organization Name:IDAHO COMMISSION ON AGING
Other - Org Name:PLANNING AND SERVICE AREA III AREA AGENCY ON AGING
Other - Org Type:Other Name
Authorized Official - Title/Position:DEPUTY ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:JEFF
Authorized Official - Middle Name:
Authorized Official - Last Name:WELLER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:208-332-1756
Mailing Address - Street 1:701 S ALLEN ST
Mailing Address - Street 2:SUITE 100
Mailing Address - City:MERIDIAN
Mailing Address - State:ID
Mailing Address - Zip Code:83642-3010
Mailing Address - Country:US
Mailing Address - Phone:208-332-1769
Mailing Address - Fax:208-888-1241
Practice Address - Street 1:701 S ALLEN ST
Practice Address - Street 2:SUITE 100
Practice Address - City:MERIDIAN
Practice Address - State:ID
Practice Address - Zip Code:83642-3010
Practice Address - Country:US
Practice Address - Phone:208-332-1769
Practice Address - Fax:208-888-1241
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-07-09
Last Update Date:2014-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management