Provider Demographics
NPI:1730216631
Name:SOCIAL ADVOCATES
Entity type:Organization
Organization Name:SOCIAL ADVOCATES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTATOR
Authorized Official - Prefix:
Authorized Official - First Name:BARBARA
Authorized Official - Middle Name:JO
Authorized Official - Last Name:BETHKE
Authorized Official - Suffix:
Authorized Official - Credentials:BS
Authorized Official - Phone:208-667-2028
Mailing Address - Street 1:1816 W WINDSOR AVE
Mailing Address - Street 2:
Mailing Address - City:COEUR D ALENE
Mailing Address - State:ID
Mailing Address - Zip Code:83815-9484
Mailing Address - Country:US
Mailing Address - Phone:208-667-2028
Mailing Address - Fax:208-665-7131
Practice Address - Street 1:1816 W WINDSOR AVE
Practice Address - Street 2:
Practice Address - City:COEUR D ALENE
Practice Address - State:ID
Practice Address - Zip Code:83815-9484
Practice Address - Country:US
Practice Address - Phone:208-667-2028
Practice Address - Fax:208-665-7131
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-27
Last Update Date:2008-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ID251B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management
Provider Identifiers
StateIdentifier IDID TypeIssuer
ID806313100Medicaid
ID806313000Medicaid