1245598424 NPI number — COMMUNITY MENTAL HEALTH SERVICES, INC.

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1245598424 NPI number — COMMUNITY MENTAL HEALTH SERVICES, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
COMMUNITY MENTAL HEALTH SERVICES, INC.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1245598424
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/25/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
720 E LANDER ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
POCATELLO
Provider Business Mailing Address State Name:
ID
Provider Business Mailing Address Postal Code:
83201-6228
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
208-478-2172
Provider Business Mailing Address Fax Number:
208-478-2174

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
720 E. LANDER
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
POCATELLO
Provider Business Practice Location Address State Name:
ID
Provider Business Practice Location Address Postal Code:
83201
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
208-478-2172
Provider Business Practice Location Address Fax Number:
208-478-2174
Provider Enumeration Date:
04/25/2012

Additional Information

Authorized Official

Authorized Official Last Name:
DAVIS
Authorized Official First Name:
AMBER
Authorized Official Middle Name:
DAWN
Authorized Official Title or Position:
OFFICE MANAGER
Authorized Official Telephone Number:
208-478-2172

Provider Taxonomy Codes

  • Taxonomy code: 251S00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





Copyright © 2007-2026 www.npivalidator.com