Provider Demographics
NPI:1134556970
Name:EASTERN IDAHO COMMUNITY ACTION PARTNERSHIP
Entity type:Organization
Organization Name:EASTERN IDAHO COMMUNITY ACTION PARTNERSHIP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:RUSSELL
Authorized Official - Middle Name:
Authorized Official - Last Name:SPAIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:208-522-5391
Mailing Address - Street 1:PO BOX 51098
Mailing Address - Street 2:
Mailing Address - City:IDAHO FALLS
Mailing Address - State:ID
Mailing Address - Zip Code:83405-1098
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:935 E LINCOLN RD
Practice Address - Street 2:
Practice Address - City:IDAHO FALLS
Practice Address - State:ID
Practice Address - Zip Code:83401-2119
Practice Address - Country:US
Practice Address - Phone:208-522-5391
Practice Address - Fax:208-522-5453
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-10-10
Last Update Date:2013-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health