Provider Demographics
NPI:1821220237
Name:IDAHO DEPARTMENT OF HEALTH AND WELFARE ESC REGION III
Entity Type:Organization
Organization Name:IDAHO DEPARTMENT OF HEALTH AND WELFARE ESC REGION III
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROGRAM MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:JEREMY
Authorized Official - Middle Name:EDMOND
Authorized Official - Last Name:PLAYER
Authorized Official - Suffix:
Authorized Official - Credentials:BSW, MS
Authorized Official - Phone:208-455-7026
Mailing Address - Street 1:823 PARKCENTRE WAY
Mailing Address - Street 2:
Mailing Address - City:NAMPA
Mailing Address - State:ID
Mailing Address - Zip Code:83651-1783
Mailing Address - Country:US
Mailing Address - Phone:208-455-7026
Mailing Address - Fax:
Practice Address - Street 1:823 PARKCENTRE WAY
Practice Address - Street 2:
Practice Address - City:NAMPA
Practice Address - State:ID
Practice Address - Zip Code:83651-1783
Practice Address - Country:US
Practice Address - Phone:208-455-7026
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-08-18
Last Update Date:2009-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management