Provider Demographics
NPI:1720182926
Name:BETTER OUTLOOK FAMILY RESOURCE CENTER
Entity Type:Organization
Organization Name:BETTER OUTLOOK FAMILY RESOURCE CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CO-OWNER-BUSINESS MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:ANGELA
Authorized Official - Middle Name:VERONICA
Authorized Official - Last Name:BLOM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:208-478-2050
Mailing Address - Street 1:427 N 4TH AVE
Mailing Address - Street 2:
Mailing Address - City:POCATELLO
Mailing Address - State:ID
Mailing Address - Zip Code:83201
Mailing Address - Country:US
Mailing Address - Phone:208-478-2050
Mailing Address - Fax:208-478-1601
Practice Address - Street 1:495 N SHILLING AVE
Practice Address - Street 2:
Practice Address - City:BLACKFOOT
Practice Address - State:ID
Practice Address - Zip Code:83221-2336
Practice Address - Country:US
Practice Address - Phone:208-782-2050
Practice Address - Fax:208-785-2297
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-11
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ID80737300Medicaid