Provider Demographics
NPI:1265582829
Name:IDAHO FALLS GROUP HOMES
Entity type:Organization
Organization Name:IDAHO FALLS GROUP HOMES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:REX
Authorized Official - Middle Name:S
Authorized Official - Last Name:REDDEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:208-523-0053
Mailing Address - Street 1:PO BOX 50457
Mailing Address - Street 2:
Mailing Address - City:IDAHO FALLS
Mailing Address - State:ID
Mailing Address - Zip Code:83405
Mailing Address - Country:US
Mailing Address - Phone:208-523-0053
Mailing Address - Fax:208-529-3134
Practice Address - Street 1:275 ASH ST
Practice Address - Street 2:
Practice Address - City:IDAHO FALLS
Practice Address - State:ID
Practice Address - Zip Code:83402-4040
Practice Address - Country:US
Practice Address - Phone:208-523-0053
Practice Address - Fax:208-529-3134
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-12
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ID71315P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes315P00000XNursing & Custodial Care FacilitiesIntermediate Care Facility, Intellectual Disabilities