OrganizationActive
Adolescent & Child Development Center, LLC
NPI 1063671469 · Developmental Disabilities Clinic/Center · Pocatello, ID
Provider details
- NPI number
- 1063671469
- Entity type
- Organization
- Primary specialty
- Developmental Disabilities Clinic/CenterAmbulatory Health Care Facilities
- Authorized official
- Vance Walker, Owner/Executive Director
- License
- 261QM0850X (ID)
Practice location
151 N 3rd Ave
Suite 110
Pocatello, ID 83201-6331
Phone: (208) 232-5622
Fax: (208) 233-4639
Mailing address
151 N 3rd Ave
Pocatello, ID 83201-6331
Registry dates
- Enumerated
- 2008-06-02
- Last updated
- 2009-04-02
Source: CMS NPPES Data Dissemination (June 2026). NPI Central is not affiliated with CMS. Data is provided as-is from the public registry.