Provider Demographics
NPI:1982725461
Name:SOUTHEAST IDAHO COUNCIL OF GOVERNMENTS
Entity Type:Organization
Organization Name:SOUTHEAST IDAHO COUNCIL OF GOVERNMENTS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:AAA DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:SISTER ANTHONY MARIE
Authorized Official - Middle Name:
Authorized Official - Last Name:GREVING
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:208-233-4032
Mailing Address - Street 1:PO BOX 6079
Mailing Address - Street 2:
Mailing Address - City:POCATELLO
Mailing Address - State:ID
Mailing Address - Zip Code:83205-6079
Mailing Address - Country:US
Mailing Address - Phone:208-233-4032
Mailing Address - Fax:208-233-5232
Practice Address - Street 1:214 E CENTER ST
Practice Address - Street 2:
Practice Address - City:POCATELLO
Practice Address - State:ID
Practice Address - Zip Code:83201-6372
Practice Address - Country:US
Practice Address - Phone:208-233-4032
Practice Address - Fax:208-233-5232
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-03
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management