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STATE OF IDAHO

Intermediate Care Mentally Retarded

Hayden, Idaho

Provider NPI: 1962755868

Organization Information:
Organization Name:  STATE OF IDAHO
Organization is not Subpart
Authorized Official:  SUSAN  BROETJE  ADMINISTRATOR  208-6970625

Practice Location:
1182 WEST KYLER AVE  HAYDEN, ID 83835 US
Tel: 208-762-0244  Fax: 208-762-0269

Business Mailing Address:
1660 11TH AVE N  NAMPA, ID 83687 US
Tel: 208-442-2812  Fax: 208-467-5978

Entity Type: Organization

Taxonomy:

PrimaryCodeCategory/DescriptionStateLicense Number
Y315P00000XNursing & Custodial Care Facilities
Intermediate Care Facility, Mentally Retarded
ID81









ASSISTED LIVING JOBS ID - Page 1

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