Grand Teton Service Group

LBN: Grand Teton Service Group
Grand Teton Service Group is an health care organization with primary practice located at 329 Park Ave , Idaho Falls ID 83402-3610. The organization recently has only one registered license in Residential Treatment Facilities / Residential Treatment Facility, Mental Retardation and/or Developmental Disabilities, which is considered as the primary health care specialty. Grand Teton Service Group can be contacted via phone (208) 528-7443, or through Bowman, Lisa via phone (208) 528-7443.

Contact Information

Primary practice address
329 Park Ave Idaho Falls ID 83402-3610
Phone: (208) 528-7443
Fax: (208) 528-7321
Website:
Map and Directions
Authorized official contact:
Name: Bowman, Lisa MASTERS/PSYCHOLOGY
Phone: (208) 528-7443

Health care specialties

SpecialtyCodeLicense #State
Residential Treatment Facilities / Residential Treatment Facility, Mental Retardation and/or Developmental Disabilities 320600000X RHA-313 Idaho

Profile Details

NPI number 1548496201
LBN Legal business name Grand Teton Service Group
DBA Doing business as
Authorized official Bowman, Lisa MASTERS/PSYCHOLOGY
Entity Organization
Organization subpart 1 No
Enumeration date Jun 8th, 2009
Last updated Jun 8th, 2009 - about 16 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 1548496201 NPPES
Idaho MEDICAID 0026996

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