Provider Demographics
NPI:1710374301
Name:THE WALKER CENTER FOR ALCOHOLISM AND DRUG ABUSE, INC.
Entity Type:Organization
Organization Name:THE WALKER CENTER FOR ALCOHOLISM AND DRUG ABUSE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:COMMUNITY NETWORK MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:ELIZABETH
Authorized Official - Middle Name:AMY
Authorized Official - Last Name:KAST
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:208-934-8461
Mailing Address - Street 1:605 11TH AVE E
Mailing Address - Street 2:
Mailing Address - City:GOODING
Mailing Address - State:ID
Mailing Address - Zip Code:83330-5368
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:605 11TH AVE E
Practice Address - Street 2:
Practice Address - City:GOODING
Practice Address - State:ID
Practice Address - Zip Code:83330-5368
Practice Address - Country:US
Practice Address - Phone:208-934-8461
Practice Address - Fax:208-934-5437
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-04-21
Last Update Date:2022-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI1136-02324500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility