Provider Demographics
NPI:1720141906
Name:DIVERSIFIED SOCIAL SERVICES, INC.
Entity Type:Organization
Organization Name:DIVERSIFIED SOCIAL SERVICES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:KRISTINA
Authorized Official - Middle Name:
Authorized Official - Last Name:NICHOLAS ANDERSON
Authorized Official - Suffix:
Authorized Official - Credentials:LSW, CPRP
Authorized Official - Phone:208-762-9890
Mailing Address - Street 1:5624 N GOVERNMENT WAY STE 7B
Mailing Address - Street 2:
Mailing Address - City:DALTON GARDENS
Mailing Address - State:ID
Mailing Address - Zip Code:83815-7350
Mailing Address - Country:US
Mailing Address - Phone:208-762-9890
Mailing Address - Fax:208-762-9892
Practice Address - Street 1:5624 N GOVERNMENT WAY STE 7B
Practice Address - Street 2:
Practice Address - City:DALTON GARDENS
Practice Address - State:ID
Practice Address - Zip Code:83815-7350
Practice Address - Country:US
Practice Address - Phone:208-762-9890
Practice Address - Fax:208-762-9892
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-18
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health