Provider Demographics
NPI:1558606962
Name:TWIN FALLS COUNTY
Entity type:Organization
Organization Name:TWIN FALLS COUNTY
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:JACI
Authorized Official - Middle Name:EREN
Authorized Official - Last Name:URIE
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:208-736-5048
Mailing Address - Street 1:PO BOX 126
Mailing Address - Street 2:
Mailing Address - City:TWIN FALLS
Mailing Address - State:ID
Mailing Address - Zip Code:83303-0126
Mailing Address - Country:US
Mailing Address - Phone:208-736-5048
Mailing Address - Fax:208-735-2126
Practice Address - Street 1:630 ADDISON AVE W STE 1000
Practice Address - Street 2:
Practice Address - City:TWIN FALLS
Practice Address - State:ID
Practice Address - Zip Code:83301-5853
Practice Address - Country:US
Practice Address - Phone:208-736-5048
Practice Address - Fax:208-735-2126
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:TWIN FALLS COUNTY
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2012-12-11
Last Update Date:2020-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
251B00000X, 261QM0801X, 324500000X, 251S00000X
ID261QR0405X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
No251B00000XAgenciesCase Management
No261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
No261QR0405XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Substance Use Disorder
No324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
ID1558606962Medicaid