GRAND TETON SERVICE GROUP NPI 1548496201

NPI Information

GRAND TETON SERVICE GROUP is a residential treatment facility, intellectual and/or developmental disabilities in Idaho Falls, ID. The provider is a residential facility that provides habilitation services and other care and treatment to adults or children diagnosed with developmental and intellectual disabilities and are not able to live independently. GRAND TETON SERVICE GROUP NPI is 1548496201. The provider is registered as an organization entity type.

The provider's business location address is:

329 PARK AVE
IDAHO FALLS, ID
ZIP 83402-610
Phone: (208) 528-7443
Fax: (208) 528-7321

The provider's authorized official is Lisa Bowman .
The authorized official title is Program Director and has the following contact phone number (208) 528-7443.

The enumeration date for this NPI number is 6/8/2009 and was last updated on 6/8/2009.

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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