Provider Demographics
NPI:1760680847
Name:IDAHO SCHOOL FOR THE DEAF AND THE BLIND
Entity Type:Organization
Organization Name:IDAHO SCHOOL FOR THE DEAF AND THE BLIND
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF CURRICULUM
Authorized Official - Prefix:
Authorized Official - First Name:GRETCHEN
Authorized Official - Middle Name:
Authorized Official - Last Name:SPOONER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:208-934-4457
Mailing Address - Street 1:1450 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:GOODING
Mailing Address - State:ID
Mailing Address - Zip Code:83330-1839
Mailing Address - Country:US
Mailing Address - Phone:208-934-4457
Mailing Address - Fax:208-934-8352
Practice Address - Street 1:1450 MAIN ST
Practice Address - Street 2:
Practice Address - City:GOODING
Practice Address - State:ID
Practice Address - Zip Code:83330-1839
Practice Address - Country:US
Practice Address - Phone:208-934-4457
Practice Address - Fax:208-934-8352
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:IDAHO SCHOOL FOR THE DEAF AND THE BLIND
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-07-10
Last Update Date:2007-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251300000XAgenciesLocal Education Agency (LEA)
Provider Identifiers
StateIdentifier IDID TypeIssuer
ID0028201MedicaidID MEDICAID PROVIDER NUMB