IDAHO DEPT OF HEALTH & WELFARE REG 1 AMH PSR CDA

COEUR D ALENE, ID
NPI1023145893
Entity TypeOrganization
Authorized ContactCORA JO GUSSENHOVEN
Program Manager
208-769-1406
Organization Subpart ?No
Primary Taxonomy261QM0801X 
Enumeration Date2007-02-27
Last Update Date2020-08-22
Business Address
IDAHO DEPT OF HEALTH & WELFARE REG 1 AMH PSR CDA
2195 IRONWOOD CT
COEUR D ALENE, ID 83814-2628
Phone number: 208-769-1406
Mailing Address
IDAHO DEPT OF HEALTH & WELFARE REG 1 AMH PSR CDA
2195 IRONWOOD CT
COEUR D ALENE, ID 83814-2628
Phone number: 208-769-1406
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