| Childrens Supportive Services Incorporated | |
|
625 W Pacific St Suite 2 Blackfoot ID 83221-2034 | |
| (208) 524-8996 | |
| (208) 524-1205 |
| Full Name | Childrens Supportive Services Incorporated |
|---|---|
| Speciality | Community/behavioral Health |
| Location | 625 W Pacific St, Blackfoot, Idaho |
| Authorized Official Name and Position | Cathie Crane (SECRETARY-TREASURER) |
| Authorized Official Contact | 2085248996 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Childrens Supportive Services Incorporated 1565 E Lincoln Rd Idaho Falls ID 83401-2129 Ph: (208) 524-8996 | Childrens Supportive Services Incorporated 625 W Pacific St Suite 2 Blackfoot ID 83221-2034 Ph: (208) 524-8996 |
| NPI Number | 1467679035 |
|---|---|
| Provider Enumeration Date | 04/18/2007 |
| Last Update Date | 12/02/2009 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1467679035 | NPI | - | NPPES |
| 807373200 | Medicaid | ID |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 251S00000X | Community/behavioral Health | (* (Not Available)) | Primary |
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