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C. L. BUTCH OTTER GOVERNOR RICHARD M. ARMSTRONG DIRECTOR TAMARA PRISOCK ADMINISTRATOR DIVISION OF LICENSING CERTIFICATION STEVEN L. MILLWARD MANAGER CERTIFIED FAMILY HOME PROGRAM 1720 Westgate Dr. Ste. B Boise ID 83704 PHONE 208 334-0706 FAX 208 239-6250 www. cfh. dhw. idaho. gov MODIFICATION TO THE APPLICATION FOR CFH CERTIFICATION or REQUEST FOR ANNUAL RECERTIFICATION Provider Name Telephone Number Address Please check mark ALL that apply to the type of change requested Change in types...

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