Provider Demographics
NPI:1194115378
Name:CASE MANAGERS OF IDAHO, LLC
Entity type:Organization
Organization Name:CASE MANAGERS OF IDAHO, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:PATRICK
Authorized Official - Middle Name:TIMOTHY
Authorized Official - Last Name:KIRK
Authorized Official - Suffix:
Authorized Official - Credentials:BA
Authorized Official - Phone:208-982-7701
Mailing Address - Street 1:1111 S ORCHARD ST
Mailing Address - Street 2:SUITE #157
Mailing Address - City:BOISE
Mailing Address - State:ID
Mailing Address - Zip Code:83705-1966
Mailing Address - Country:US
Mailing Address - Phone:208-982-7701
Mailing Address - Fax:208-209-7186
Practice Address - Street 1:1111 S ORCHARD ST
Practice Address - Street 2:SUITE #157
Practice Address - City:BOISE
Practice Address - State:ID
Practice Address - Zip Code:83705-1966
Practice Address - Country:US
Practice Address - Phone:208-982-7701
Practice Address - Fax:208-209-7186
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-01-27
Last Update Date:2016-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ID251B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management