Provider Demographics
NPI:1487869939
Name:WITCO, INC.
Entity type:Organization
Organization Name:WITCO, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT & CEO
Authorized Official - Prefix:MS
Authorized Official - First Name:MAUREEN
Authorized Official - Middle Name:ELLEN
Authorized Official - Last Name:STOKES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:208-454-3051
Mailing Address - Street 1:3919 E USTICK RD
Mailing Address - Street 2:
Mailing Address - City:CALDWELL
Mailing Address - State:ID
Mailing Address - Zip Code:83605-6508
Mailing Address - Country:US
Mailing Address - Phone:208-454-3051
Mailing Address - Fax:208-454-3053
Practice Address - Street 1:122 W. GEORGIA AVENUE
Practice Address - Street 2:
Practice Address - City:NAMPA
Practice Address - State:ID
Practice Address - Zip Code:83686-2864
Practice Address - Country:US
Practice Address - Phone:208-454-3051
Practice Address - Fax:208-454-3053
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-10
Last Update Date:2025-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251C00000XAgenciesDay Training, Developmentally Disabled Services
No261QA0600XAmbulatory Health Care FacilitiesClinic/CenterAdult Day Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
ID805029000Medicaid
ID806231701Medicaid
ID000127700Medicaid
ID000127900Medicaid