NPI 1215097480

Club, INC.

Organisation Voluntary or Charitable Agency Idaho Falls, ID

Practice location

Address: 2001 S Woodruff Ave Suite 6, Idaho Falls, ID 83404-6374
Phone: (208) 529-4673
Fax: (208) 529-4676

Authorised official

Name: Mardee Harper
Title: Executive Director
Phone: (208) 529-4673

Registered specialties

Voluntary or Charitable Agency Primary

Agencies Taxonomy 251V00000X

Other Voluntary or Charitable providers in Idaho →

Registry record

NPI: 1215097480
Entity type: Organization
NPI issued: 11 Dec 2006
Record last updated: 22 Aug 2020

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.