NPI 1063671469

Adolescent & Child Development Center, LLC

Organisation Developmental Disabilities Clinic/Center Pocatello, ID

Practice location

Address: 151 N 3rd Ave Suite 110, Pocatello, ID 83201-6331
Phone: (208) 232-5622
Fax: (208) 233-4639

Authorised official

Name: Vance Ray Walker
Title: Owner/Executive Director
Phone: (208) 232-5622

Registered specialties (3)

Developmental Disabilities Clinic/Center Primary

Ambulatory Health Care Facilities Taxonomy 261QD1600X Licence 261QD1600X (ID)

Other Clinic/Center providers in Idaho →

Mental Health Clinic/Center (Including Community Mental Health Center)

Ambulatory Health Care Facilities Taxonomy 261QM0801X Licence 261QM0801X (ID)

Adult Mental Health Clinic/Center

Ambulatory Health Care Facilities Taxonomy 261QM0850X Licence 261QM0850X (ID)

Registry record

NPI: 1063671469
Entity type: Organization
NPI issued: 2 Jun 2008
Record last updated: 2 Apr 2009

Reproduced from NPPES, the federal provider registry. The date above is when the provider last updated their own entry, not when we fetched it - a record can be years old and still current in the registry.