| Snake River Community Supported Living | |
|
557 S Woodruff Ave Idaho Falls ID 83401-5200 | |
| (208) 542-4517 | |
| Not Available |
| Full Name | Snake River Community Supported Living |
|---|---|
| Speciality | Community/behavioral Health |
| Location | 557 S Woodruff Ave, Idaho Falls, Idaho |
| Authorized Official Name and Position | Kathleen Ann Hansen (OWNER/ADMINISTRATOR) |
| Authorized Official Contact | 2085424517 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Snake River Community Supported Living 557 S Woodruff Ave Idaho Falls ID 83401-5200 Ph: (208) 542-4517 | Snake River Community Supported Living 557 S Woodruff Ave Idaho Falls ID 83401-5200 Ph: (208) 542-4517 |
| NPI Number | 1851706626 |
|---|---|
| Provider Enumeration Date | 06/30/2014 |
| Last Update Date | 06/30/2014 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1851706626 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 251S00000X | Community/behavioral Health | (* (Not Available)) | Primary |
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