| Bannock Youth Foundation | |
|
110 South 19th Pocatello ID 83201 | |
| (208) 234-4722 | |
| (208) 234-2135 |
| Full Name | Bannock Youth Foundation |
|---|---|
| Speciality | Counselor - Addiction (substance Use Disorder) |
| Location | 110 South 19th, Pocatello, Idaho |
| Authorized Official Name and Position | Cindy K Hansen (CLINICAL DIRECTOR) |
| Authorized Official Contact | 2082344722 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Bannock Youth Foundation P.o. Box 246 Pocatello ID 83204 Ph: (208) 234-4722 | Bannock Youth Foundation 110 South 19th Pocatello ID 83201 Ph: (208) 234-4722 |
| NPI Number | 1245665470 |
|---|---|
| Provider Enumeration Date | 09/06/2013 |
| Last Update Date | 09/06/2013 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1245665470 | NPI | - | NPPES |
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