Provider Demographics
NPI:1972771392
Name:COORDINATED CARE SERVICES
Entity type:Organization
Organization Name:COORDINATED CARE SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:GENERAL PARTNER
Authorized Official - Prefix:MS
Authorized Official - First Name:MELINDA
Authorized Official - Middle Name:B
Authorized Official - Last Name:JAHSMAN
Authorized Official - Suffix:
Authorized Official - Credentials:MHE
Authorized Official - Phone:208-478-1353
Mailing Address - Street 1:250 N 5TH AVE
Mailing Address - Street 2:SUITE E
Mailing Address - City:POCATELLO
Mailing Address - State:ID
Mailing Address - Zip Code:83201-6278
Mailing Address - Country:US
Mailing Address - Phone:208-478-1353
Mailing Address - Fax:208-478-1957
Practice Address - Street 1:250 N 5TH AVE
Practice Address - Street 2:SUITE E
Practice Address - City:POCATELLO
Practice Address - State:ID
Practice Address - Zip Code:83201-6278
Practice Address - Country:US
Practice Address - Phone:208-478-1353
Practice Address - Fax:208-478-1957
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-19
Last Update Date:2008-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management
Provider Identifiers
StateIdentifier IDID TypeIssuer
ID=========Medicaid