GEM STATE DEVELOPMENTAL CENTER LLC (NPI# 1023667524) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1023667524 |
| Entity Type | Organization |
| Organization Name | GEM STATE DEVELOPMENTAL CENTER LLC |
| Practice Address |
818 Nw 15th St Meridian ID 83642-3724 |
| Practice Telephone | 2088885566 |
| Practice Fax Number | 2088885578 |
| Mailing Telephone | 2088885566 |
| Mailing Fax Number | 2088885578 |
| Enumeration Date | 2019-09-06 |
| Last Update Date | 2019-09-06 |
| Authorized Official Name | MS. LORI JO POOLE (CLINICAL DIRECTOR) |
| Authorized Official Telephone | 2088885566 |
| Authorized Official Credential | LCSW |
| Is Organization Subpart | Y |
| Parent Organization Name | SYRINGA SOCIAL SERVICES LLC |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 373H00000X | Day Training/Habilitation Specialist | Nursing Service Related Providers |
| Other Name | Type Code |
|---|---|
| Gem State Developmental Center | Doing Business As Name - Organization |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1760523062 | Gem State Developmental Center LLC | Day Training, Developmentally Disabled Services | 818 Nw 15th St, Meridian, ID 83642-3724 | 2007-02-09 |
| Street Address |
818 NW 15TH ST |
| City | MERIDIAN |
| State | ID |
| Zip Code | 83642-3724 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1760523062 | Gem State Developmental Center LLC | Day Training, Developmentally Disabled Services | 818 Nw 15th St, Meridian, ID 83642-3724 | 2007-02-09 |
| 1962762534 | Lori Jo Poole | Social Worker | 818 Nw 15th St, Meridian, ID 83642-3724 | 2012-05-16 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1174145684 | Ikdo South Meridian LLC | Dentist | 3839 E Amity Rd, Meridian, ID 83642 | 2020-05-07 |
| 1073133328 | Prescription Pad LLC | Pharmacy | 885 S Vanguard Way, Meridian, ID 83642 | 2020-04-16 |
| 1609412683 | Meridian Advanced Psychiatry, LLC | Psychiatry & Neurology | 1672 S Woodsage Ave., Meridan, ID 83642 | 2019-11-25 |
| 1194378927 | Sergey Tsema | Occupational Therapist | 1259 E Pisa St, Meridian, ID 83642 | 2019-07-21 |
| 1003478629 | Chris R Jackson | Dentist | Isu Family Dentistry, 1311 E Central Dr, Meridian, ID 83642 | 2019-07-03 |
| 1285293118 | Morgan Family Medicine | Nurse Practitioner | 1660 S Woodsage Avenue, Meridian, ID 83642 | 2019-06-13 |
| 1033772793 | Nugen Healthcare, Pllc | Registered Nurse | 2177 S Spoonbill Ave, Meridian, ID 83642 | 2019-04-18 |
| 1811471790 | Courtney Crossland | Physician Assistant | 4949 S Hillsdale Ave., Meridian, ID 83642 | 2018-09-18 |
| 1841771938 | Katelyn Perry | Counselor | 2068 S. Eagle Rd., Meridian, ID 83642 | 2018-08-27 |
| 1114406204 | Gem Prep: Meridian LLC | Case Management | 2750 E.gala Ct., Meridian, ID 83642 | 2018-08-09 |
| Find all providers in zip 83642 | ||||
| Taxonomy Code | 373H00000X |
| Grouping | Nursing Service Related Providers |
| Classification | Day Training/Habilitation Specialist |
| Individuals experienced or trained in working with developmentally disabled individuals who need assistance in acquiring and maintaining life skills that enable them to cope more effectively with the demands of independent living. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1770611584 | Ginger J Smart | Day Training/Habilitation Specialist | 1775 Waltman St, Meridian, ID 83642-6123 | 2007-03-01 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1881248789 | Aarow Bond Ellis | Day Training/Habilitation Specialist | 2961 Upper Pack River Rd, Sandpoint, ID 83864-4935 | 2019-07-29 |
| 1174721732 | Joseph Val Larsen | Day Training/Habilitation Specialist | 2257 Diane Lane, Pocatello, ID 83201-1911 | 2007-07-05 |
| 1225540537 | Exceptional Child Center, Inc. | Day Training/Habilitation Specialist | 1411 Falls Ave E Ste 703, Twin Falls, ID 83301-3455 | 2017-10-26 |
| 1760471262 | A Way Through Counseling Center Inc | Day Training/Habilitation Specialist | 306 N Spokane St, Suite I, Post Falls, ID 83854-7016 | 2005-10-18 |
Please comment or provide details below to improve the information on GEM STATE DEVELOPMENTAL CENTER LLC.
| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.