NPI: 1760783153 · IDAHO FALLS, ID 83404 · Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility · NPI assigned 11/16/2010
| Authorized Official | BOWMAN, LISA (PROGRAM DIRECTOR) |
| NPI Enumeration Date | 11/16/2010 |
Other providers sharing the same authorized official: BOWMAN, LISA
| Provider | City | State | Total Paid |
|---|---|---|---|
| GRAND TETON SERVICE GROUP | IDAHO FALLS | ID | $104K |
| Year | Claims | Total Paid |
|---|---|---|
| 2018 | 41 | $55K |
| Code | Description | Claims | Beneficiaries | Total Paid |
|---|---|---|---|---|
| H2022 | Community-based wrap-around services, per diem | 41 | 13 | $55K |