Provider Demographics
NPI:1396876850
Name:IDAHO DEPT. OF HEALTH & WELFARE
Entity type:Organization
Organization Name:IDAHO DEPT. OF HEALTH & WELFARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:HUMAN SERVICES FIELD PROGRAM MANAGE
Authorized Official - Prefix:
Authorized Official - First Name:SCOTT
Authorized Official - Middle Name:
Authorized Official - Last Name:RASMUSSEN
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:208-732-1601
Mailing Address - Street 1:803 HARRISON ST.
Mailing Address - Street 2:
Mailing Address - City:TWIN FALLS
Mailing Address - State:ID
Mailing Address - Zip Code:83301-3925
Mailing Address - Country:US
Mailing Address - Phone:208-732-1630
Mailing Address - Fax:208-736-2135
Practice Address - Street 1:803 HARRISON ST.
Practice Address - Street 2:
Practice Address - City:TWIN FALLS
Practice Address - State:ID
Practice Address - Zip Code:83301-3925
Practice Address - Country:US
Practice Address - Phone:208-732-1630
Practice Address - Fax:208-736-2135
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:IDAHO DEPT. OF HEALTH & WELFARE
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-03-08
Last Update Date:2019-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
No261QR0400XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
ID0028404Medicaid
IDHW140OtherBLUE CROSS
ID000010025422OtherBLUE SHIELD