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13D2099308 CLIA NUMBER - MOUNTAIN STATES CHEMICAL DEPENDECY & COUSELING SVS

Laboratory Demographics

CLIA Number: 13D2099308

Facility Name: MOUNTAIN STATES CHEMICAL DEPENDECY & COUSELING SVS

Facility Address:
1305 2ND ST S #201
NAMPA, ID
ZIP 83651
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Facility Phone Number: 208 463-0202

Facility Type: Comp. Outpatient Rehab Facility

Certificate Type: Waiver
NPI Number: 1043368418

Taxonomy: 251S00000X - Community/Behavioral Health
A private or public agency usually under local government jurisdiction, responsible for assuring the delivery of community based mental health, intellectual disabilities, substance abuse and/or behavioral health services to individuals with those disabilities. Services may range from companion care, respite, transportation, community integration, crisis intervention and stabilization, supported employment, day support, prevocational services, residential support, therapeutic and supportive consultation, environmental modifications, intensive in-home therapy and day treatment, in addition to traditional mental health and behavioral treatment.

CLIA Record

Field Name Field Value
CLIA Number 13D2099308
LAB Type Comp. Outpatient Rehab Facility
Facility Name MOUNTAIN STATES CHEMICAL DEPENDECY & COUSELING SVS
Street 1305 2ND ST S #201
City NAMPA
State ID
ZIP 83651
Phone 208 463-0202
CertificateType 4
CertificateEffectiveDate 7/24/2023
CertificateExpirationDate 7/23/2025
FacilityType Waiver

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This page was last updated on: 4/23/2024