Provider Demographics
NPI:1760684153
Name:NORTH STAR CHILD DEVELOPMENT CENTER
Entity Type:Organization
Organization Name:NORTH STAR CHILD DEVELOPMENT CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:BILLIE JO
Authorized Official - Middle Name:
Authorized Official - Last Name:DAVIS
Authorized Official - Suffix:
Authorized Official - Credentials:BCBA
Authorized Official - Phone:208-765-6828
Mailing Address - Street 1:1583 W DALTON AVE
Mailing Address - Street 2:
Mailing Address - City:COEUR D ALENE
Mailing Address - State:ID
Mailing Address - Zip Code:83815-8962
Mailing Address - Country:US
Mailing Address - Phone:208-765-6828
Mailing Address - Fax:208-765-5893
Practice Address - Street 1:1583 W DALTON AVE
Practice Address - Street 2:
Practice Address - City:COEUR D ALENE
Practice Address - State:ID
Practice Address - Zip Code:83815-8962
Practice Address - Country:US
Practice Address - Phone:208-765-6828
Practice Address - Fax:208-765-5893
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-05
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ID1NSCDC136261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center