Adolescent & Child Development Center, Llc

LBN: Adolescent & Child Development Center, Llc
Adolescent & Child Development Center, Llc is an health care organization with primary practice located at 151 N 3Rd Ave Suite 110, Pocatello ID 83201-6331. The organization recently has 3 registered licenses in different health care specialties including Ambulatory Health Care Facilities / Developmental Disabilities, Ambulatory Health Care Facilities / Mental Health (Including Community Mental Health Center), Ambulatory Health Care Facilities / Adult Mental Health. Ambulatory Health Care Facilities / Developmental Disabilities is the primary health care specialty. Adolescent & Child Development Center, Llc can be contacted via phone (208) 232-5622, or through Walker, Vance Ray via phone (208) 232-5622.

Contact Information

Primary practice address
151 N 3Rd Ave Suite 110 Pocatello ID 83201-6331
Phone: (208) 232-5622
Fax: (208) 233-4639
Website:
Map and Directions
Authorized official contact:
Name: Walker, Vance Ray
Phone: (208) 232-5622

Health care specialties

SpecialtyCodeLicense #State
Ambulatory Health Care Facilities / Developmental Disabilities 261QD1600X 261QD1600X Idaho
Ambulatory Health Care Facilities / Mental Health (Including Community Mental Health Center) 261QM0801X 261QM0801X Idaho
Ambulatory Health Care Facilities / Adult Mental Health 261QM0850X 261QM0850X Idaho

Profile Details

NPI number 1063671469
LBN Legal business name Adolescent & Child Development Center, Llc
DBA Doing business as
Authorized official Walker, Vance Ray
Entity Organization
Organization subpart 1 No
Enumeration date Jun 2nd, 2008
Last updated Apr 2nd, 2009 - about 15 years ago

1 Some organizations, which are providing health care services, may consist of units or departments that provide different types of health care services or have several separate physical locations, where health care service is provided. These units, departments or physical locations are not themselves legal entities. However, each of them is part of the organization, which is a legal entity. The organization may decide whether its subparts, if it has any, should have their own NPI numbers. In case a subpart conducts any HIPAA standard transactions by itself, without its parent's involvement, it must have its own NPI number.

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Identifiers

StateTypeNumberIssuer
All States NPI 1063671469 NPPES
Idaho MEDICAID 808259000
Idaho MEDICAID 808257100
Idaho MEDICAID 808028200

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