An entity, facility, or distinct part of a facility providing diagnostic, treatment, and prescriptive services related to mental and behavioral disorders in adults.
taxonomy 261QM0850X
Clinic/Center
An entity, facility, or distinct part of a facility providing diagnostic, treatment, and prescriptive services related to mental and behavioral disorders in children and adolescents. Services may be provided to parents and family...
taxonomy 261QM0855X
Identifiers
Type
Value
Notes
01 (IL)
L8067
BLUE CROSS OF IDAHO
05 (ID)
20015619
Other names on file (1)
Doing-business-as, former, and alternate names recorded by NPPES.
Yolanda Ponder
Type code 3recorded 2020-10-12
Practice context
Multi-site organization.
2 additional practice locations on file.
Subpart of Maize Holding Company, Llc.
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