Provider Demographics
NPI:1942632500
Name:ADA COUNTY JUVENILE COURT SERVICES
Entity Type:Organization
Organization Name:ADA COUNTY JUVENILE COURT SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:JANET
Authorized Official - Middle Name:
Authorized Official - Last Name:WALLACE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:208-577-4811
Mailing Address - Street 1:6300 W DENTON ST
Mailing Address - Street 2:
Mailing Address - City:BOISE
Mailing Address - State:ID
Mailing Address - Zip Code:83704-9326
Mailing Address - Country:US
Mailing Address - Phone:208-577-4800
Mailing Address - Fax:208-287-5609
Practice Address - Street 1:400 N BENJAMIN LN
Practice Address - Street 2:SUITE 201
Practice Address - City:BOISE
Practice Address - State:ID
Practice Address - Zip Code:83704-5094
Practice Address - Country:US
Practice Address - Phone:208-287-5612
Practice Address - Fax:208-287-5609
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-08-06
Last Update Date:2013-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ID251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health