Provider Demographics
NPI:1174389829
Name:IDAHO DEPARTMENT OF HEALTH & WELFARE
Entity type:Organization
Organization Name:IDAHO DEPARTMENT OF HEALTH & WELFARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATIVE SUPPORT MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:CHRISTINA
Authorized Official - Middle Name:
Authorized Official - Last Name:GALLEGOS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:208-606-7777
Mailing Address - Street 1:1652 11TH AVE N
Mailing Address - Street 2:
Mailing Address - City:NAMPA
Mailing Address - State:ID
Mailing Address - Zip Code:83687-5000
Mailing Address - Country:US
Mailing Address - Phone:208-606-7777
Mailing Address - Fax:208-606-7800
Practice Address - Street 1:1652 11TH AVE N
Practice Address - Street 2:
Practice Address - City:NAMPA
Practice Address - State:ID
Practice Address - Zip Code:83687-5000
Practice Address - Country:US
Practice Address - Phone:208-606-7777
Practice Address - Fax:208-606-7800
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:IDAHO DEPARTMENT OF HEALTH & WELFARE
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2024-02-21
Last Update Date:2024-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty