Provider Demographics
NPI:1518701705
Name:NORTHWEST CHILDREN'S HOME
Entity type:Organization
Organization Name:NORTHWEST CHILDREN'S HOME
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:BOOKKEEPER
Authorized Official - Prefix:
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:
Authorized Official - Last Name:SKEELS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:208-743-9404
Mailing Address - Street 1:419 22ND AVE
Mailing Address - Street 2:
Mailing Address - City:LEWISTON
Mailing Address - State:ID
Mailing Address - Zip Code:83501-3812
Mailing Address - Country:US
Mailing Address - Phone:208-746-3388
Mailing Address - Fax:
Practice Address - Street 1:419 22ND AVE
Practice Address - Street 2:
Practice Address - City:LEWISTON
Practice Address - State:ID
Practice Address - Zip Code:83501-3812
Practice Address - Country:US
Practice Address - Phone:208-746-3388
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:NORTHWEST CHILDREN'S HOME, INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2024-06-21
Last Update Date:2024-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes323P00000XResidential Treatment FacilitiesPsychiatric Residential Treatment Facility
No2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty