ADOLESCENT & CHILD DEVELOPMENT CENTER LLC NPI 1063671469

NPI Information

ADOLESCENT & CHILD DEVELOPMENT CENTER, LLC is a developmental disabilities clinic center in Pocatello, ID. The provider is an entity, facility, or distinct part of a facility providing comprehensive, multidiscipline diagnostic, treatment, therapy, training, and counseling services to children with congenital disorders that precipitate developmental delays and in many instances mental deficiencies (e.g., Cerebral Palsy, metabolic disorders, Sturge-Weber Syndrome, etc.). ADOLESCENT & CHILD DEVELOPMENT CENTER, LLC NPI is 1063671469. The provider is registered as an organization entity type.

The provider's business location address is:

151 N 3RD AVE
SUITE 110
POCATELLO, ID
ZIP 83201-331
Phone: (208) 232-5622
Fax: (208) 233-4639

The provider's authorized official is Vance Ray Walker .
The authorized official title is Owner/executive Director and has the following contact phone number (208) 232-5622.

The enumeration date for this NPI number is 6/2/2008 and was last updated on 4/2/2009.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

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