NPIMap

Organization Active NPI

Blackfoot Behavioral Health, LLC

  • Psychiatric Residential Treatment Facility
  • Blackfoot, ID
National Provider Identifier
1003113465
Registry record updated Feb 22, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
Psychiatric Residential Treatment FacilityTaxonomy code 323P00000X
License
LCSW26332 Issued in ID
Legal business name
BLACKFOOT BEHAVIORAL HEALTH, LLC
Practice address
75 Lilac St
Blackfoot, ID 83221-1768
Phone
(208) 782-1322
Fax
(208) 782-1074
NPI assigned
Feb 22, 2011
Last updated
Feb 22, 2011By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Feb 22, 2011

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Sandee Young, LCSWNPI 1215177704
Title
Administrator
Phone
(208) 680-0542

Authorized official NPPES reports the official by name only. The link goes to the one practitioner with that name whose NPPES practice address or phone number is this organization’s.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Psychiatric Residential Treatment Facility 323P00000X LCSW26332 ID Primary

Addresses

Primary practice location

75 Lilac St
Blackfoot, ID 83221-1768

Mailing address

75 Lilac St
Blackfoot, ID 83221-1768
Phone (208) 782-1322

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1298332800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1298332800000",
    "number": "1003113465",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "75 LILAC ST",
            "city": "BLACKFOOT",
            "state": "ID",
            "postal_code": "832211768",
            "telephone_number": "208-782-1322",
            "fax_number": "208-782-1074"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "75 LILAC ST",
            "city": "BLACKFOOT",
            "state": "ID",
            "postal_code": "832211768",
            "telephone_number": "208-782-1322",
            "fax_number": "208-782-1074"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BLACKFOOT BEHAVIORAL HEALTH, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-02-22",
        "last_updated": "2011-02-22",
        "status": "A",
        "authorized_official_last_name": "YOUNG",
        "authorized_official_first_name": "SANDEE",
        "authorized_official_title_or_position": "ADMINISTRATOR",
        "authorized_official_telephone_number": "208-680-0542",
        "authorized_official_credential": "LCSW"
    },
    "taxonomies": [
        {
            "code": "323P00000X",
            "taxonomy_group": "",
            "desc": "Psychiatric Residential Treatment Facility",
            "state": "ID",
            "license": "LCSW26332",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Blackfoot, ID

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 22, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.