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STATE OF IDAHO NPI 1790131027


NPI Information

NPI: 1790131027
Provider Name: STATE OF IDAHO
Classification: Community/Behavioral Health - 251S00000X
Entity Type: Organization
Address:
1720 N WESTGATE DR
BOISE, ID
ZIP 83704
Phone: (208) 334-0824
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STATE OF IDAHO is a community behavioral health in Boise, ID. The provider is a private or public agency usually under local government jurisdiction, responsible for assuring the delivery of community based mental health, intellectual disabilities, substance abuse and/or behavioral health services to individuals with those disabilities. Services may range from companion care, respite, transportation, community integration, crisis intervention and stabilization, supported employment, day support, prevocational services, residential support, therapeutic and supportive consultation, environmental modifications, intensive in-home therapy and day treatment, in addition to traditional mental health and behavioral treatment. STATE OF IDAHO NPI is 1790131027. The provider is registered as an organization entity type.

The provider's business location address is:

1720 N WESTGATE DR
BOISE, ID
ZIP 83704-164
Phone: (208) 334-0824

The provider's authorized official is Wayne Nubile .
The authorized official title is Clinical Supervisor and has the following contact phone number (208) 334-0824.

The enumeration date for this NPI number is 5/5/2016 and was last updated on 5/5/2016.


Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No. Taxonomy Code Taxonomy Clasification Taxonomy Specialization License Number License State Primary
1251S00000XCommunity/Behavioral HealthLCPC-5579IDAHOYes

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 5/5/2024

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