Provider Demographics
NPI:1649393810
Name:SPRINGFIELD DEVELOPMENT
Entity Type:Organization
Organization Name:SPRINGFIELD DEVELOPMENT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:LOREN
Authorized Official - Middle Name:
Authorized Official - Last Name:WHEELER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:205-345-7160
Mailing Address - Street 1:220 E 37TH ST STE A
Mailing Address - Street 2:
Mailing Address - City:BOISE
Mailing Address - State:ID
Mailing Address - Zip Code:83714-3414
Mailing Address - Country:US
Mailing Address - Phone:208-345-7160
Mailing Address - Fax:208-343-1064
Practice Address - Street 1:220 E 37TH ST STE A
Practice Address - Street 2:
Practice Address - City:BOISE
Practice Address - State:ID
Practice Address - Zip Code:83714-3414
Practice Address - Country:US
Practice Address - Phone:208-345-7160
Practice Address - Fax:208-343-1064
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-10
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ID0027717251B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management