Provider Demographics
NPI:1124246582
Name:SUSAN CALLS CASE MANAGEMENT
Entity type:Organization
Organization Name:SUSAN CALLS CASE MANAGEMENT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:HARRY
Authorized Official - Middle Name:B
Authorized Official - Last Name:BELL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:801-254-8864
Mailing Address - Street 1:11448 LAMPTON VIEW DR
Mailing Address - Street 2:
Mailing Address - City:SOUTH JORDAN
Mailing Address - State:UT
Mailing Address - Zip Code:84095-7814
Mailing Address - Country:US
Mailing Address - Phone:801-254-8864
Mailing Address - Fax:801-254-8864
Practice Address - Street 1:313 D ST
Practice Address - Street 2:SUITE 203
Practice Address - City:LEWISTON
Practice Address - State:ID
Practice Address - Zip Code:83501-1894
Practice Address - Country:US
Practice Address - Phone:208-798-8070
Practice Address - Fax:208-798-8068
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-23
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management
Provider Identifiers
StateIdentifier IDID TypeIssuer
ID0027740Medicaid
ID8042962Medicaid
ID8054196Medicaid
ID8066251Medicaid
ID0027739Medicaid