Provider Demographics
NPI:1013431816
Name:GEM PREP: POCATELLO, INC.
Entity Type:Organization
Organization Name:GEM PREP: POCATELLO, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:BARB
Authorized Official - Middle Name:
Authorized Official - Last Name:FEMREITE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:208-877-1513
Mailing Address - Street 1:PO BOX 338
Mailing Address - Street 2:
Mailing Address - City:DEARY
Mailing Address - State:ID
Mailing Address - Zip Code:83823-0338
Mailing Address - Country:US
Mailing Address - Phone:208-877-1513
Mailing Address - Fax:208-877-1713
Practice Address - Street 1:1451 JESSIE CLARK LN
Practice Address - Street 2:
Practice Address - City:POCATELLO
Practice Address - State:ID
Practice Address - Zip Code:83202-2787
Practice Address - Country:US
Practice Address - Phone:208-877-1513
Practice Address - Fax:208-877-1713
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-08-02
Last Update Date:2017-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management