NPI 1578724910

Grand Teton Service Group

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

Practice location

Address: 329 Park Ave, Idaho Falls, ID 83402-3610
Phone: (208) 528-7443
Fax: (208) 529-3134
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 Community Based Residential Treatment Facility Primary

Residential Treatment Facilities Taxonomy 320900000X Licence 806915000 (ID)

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

Registry record

NPI: 1578724910
Entity type: Organization
NPI issued: 18 Jun 2008
Record last updated: 18 Jun 2008

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.