NPI 1356577019

Grand Teton Service Group

Organisation Intellectual and/or Developmental Disabilities Residential Treatment Facility Idaho Falls, ID

Practice location

Address: 329 Park Ave, Idaho Falls, ID 83402-3610
Phone: (208) 528-7443
Fax: (208) 528-7321
Mailing address: PO Box 50457, Idaho Falls, ID 83405-0457

Authorised official

Name: Lisa Bowman
Title: Program Director
Phone: (208) 528-7443

Registered specialties

Intellectual and/or Developmental Disabilities Residential Treatment Facility Primary

Residential Treatment Facilities Taxonomy 320600000X Licence RHA-313 (ID)

Other Residential Treatment Facility, Intellectual and/or Developmental Disabilities providers in Idaho →

Registry record

NPI: 1356577019
Entity type: Organization
NPI issued: 8 Jun 2009
Record last updated: 8 Jun 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.