IDAHO DEPT OF HEALTH & WELFARE AMH PSR MT HOME NPI 1720118904

NPI Information

NPI: 1720118904
Provider Name: IDAHO DEPT OF HEALTH & WELFARE AMH PSR MT HOME
Classification: Clinic/Center - 261QM0801X
Entity Type: Organization

Specialization: Mental Health (Including Community Mental Health Center)

Address:
2420 AMERICAN LEGION BLVD
MOUNTAIN HOME, ID
ZIP 83647
Phone: (208) 587-9061
Get Directions

IDAHO DEPT OF HEALTH & WELFARE AMH PSR MT HOME is a mental health (including community mental health center) clinic center in Mountain Home, ID. IDAHO DEPT OF HEALTH & WELFARE AMH PSR MT HOME NPI is 1720118904. The provider is registered as an organization entity type.

The provider's business location address is:

2420 AMERICAN LEGION BLVD
MOUNTAIN HOME, ID
ZIP 83647-146
Phone: (208) 587-9061
Fax: (208) 587-5024

The provider's authorized official is Gina Westcott .
The authorized official title is Program Manager and has the following contact phone number (208) 334-0969.

The enumeration date for this NPI number is 3/6/2007 and was last updated on 8/22/2020.

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
1	261QM0801X	Clinic/Center	Mental Health (Including Community Mental Health Center)			Yes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No.	Other Provider Identifier	Other Provider Identifier Type	Other Provider Identifier State	Other Provider Identifier Issuer
1	8073418	MEDICAID	IDAHO
2	000010018973	OTHER		BLUE SHIELD
3	HW280	OTHER		BLUE CROSS OF IDAHO

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: 11/14/2023

NPI Synchronization or Removal

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