Provider Demographics
NPI:1538744826
Name:STATE OF IDAHO DEPARTMENT OF HEALTH AND WELFARE
Entity type:Organization
Organization Name:STATE OF IDAHO DEPARTMENT OF HEALTH AND WELFARE
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:HOSPITAL ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:GINA
Authorized Official - Middle Name:
Authorized Official - Last Name:WESTCOTT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:208-606-7777
Mailing Address - Street 1:1652 11TH AVENUE NORTH
Mailing Address - Street 2:
Mailing Address - City:NAMPA
Mailing Address - State:ID
Mailing Address - Zip Code:83687
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1652 11TH AVENUE NORTH
Practice Address - Street 2:
Practice Address - City:NAMPA
Practice Address - State:ID
Practice Address - Zip Code:83687
Practice Address - Country:US
Practice Address - Phone:208-606-7777
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:STATE OF IDAHO DEPARTMENT OF HEALTH AND WELFARE
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2021-03-17
Last Update Date:2024-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes283Q00000XHospitalsPsychiatric Hospital