Provider Demographics
NPI:1104948322
Name:DEVELOPMENT WORKSHOP, INC.
Entity type:Organization
Organization Name:DEVELOPMENT WORKSHOP, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:DWIGHT
Authorized Official - Middle Name:
Authorized Official - Last Name:WHITTAKER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:208-524-1550
Mailing Address - Street 1:555 W 25TH ST
Mailing Address - Street 2:
Mailing Address - City:IDAHO FALLS
Mailing Address - State:ID
Mailing Address - Zip Code:83402-4527
Mailing Address - Country:US
Mailing Address - Phone:208-524-1550
Mailing Address - Fax:208-523-3148
Practice Address - Street 1:555 W 25TH ST
Practice Address - Street 2:
Practice Address - City:IDAHO FALLS
Practice Address - State:ID
Practice Address - Zip Code:83402-4527
Practice Address - Country:US
Practice Address - Phone:208-524-1550
Practice Address - Fax:208-523-3148
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-06
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ID02396600251C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251C00000XAgenciesDay Training, Developmentally Disabled Services