NPIMap

Organization Active NPI

Ambitions of Idaho, Inc

Doing business as Ambitions

  • Mental Health Clinic/Center (Including Community Mental Health Center)
  • Coeur d'Alene, ID
National Provider Identifier
1003145533
Registry record updated Oct 12, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Mental Health Clinic/Center (Including Community Mental Health Center)Taxonomy code 261QM0801X
Legal business name
AMBITIONS OF IDAHO, INC
Doing business as
Ambitions
Practice address
1044 Northwest Blvd Ste C
Coeur D Alene, ID 83814-2114
Phone
(208) 930-1740
Fax
(208) 930-1695
NPI assigned
Dec 11, 2009
Last updated
Oct 12, 2023By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 12, 2023

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

Authorized official

Name
Shane Hagel
Title
President
Phone
(208) 930-1740

Specialties & licenses 8

Specialty (taxonomy)CodeLicenseStatePrimary
Case Management Agency 251B00000X
Mental Health Clinic/Center (Including Community Mental Health Center) 261QM0801X Primary
Adult Mental Health Clinic/Center 261QM0850X
Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility 320900000X
Professional Counselor 101YP2500X
Clinical Social Worker 1041C0700X
Child & Adolescent Psychiatry Physician 2084P0804X
Community/Behavioral Health Agency 251S00000X

Addresses

Primary practice location

1044 Northwest Blvd Ste C
Coeur D Alene, ID 83814-2114

Mailing address

1044 Northwest Blvd Ste C
Coeur D Alene, ID 83814-2114
Phone (208) 930-1740

Other identifiers 1

IdentifierTypeStateIssuer
8079051MedicaidID

Other names 1

  • Ambitions Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in ID

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20170314000619 ID Part B Supplier - Clinic/Group Practice 6305121328 Receives reassigned benefits from 9 practitioners
1 other NPI on this enrollment
Practice locations: Coeur D Alene, ID

Other NPIs on the same Medicare enrollment 1

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

National Provider Directory

National Provider Directory

Locations

511 N Argonne Rd
Ste 200
Spokane Valley, WA 99212
Phone (509) 321-0414

Practitioners & affiliated clinicians

Practitioners 14

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.

View all 14

NPI Registry JSON

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

{
    "created_epoch": "1260489600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1697068800000",
    "number": "1003145533",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1044 NORTHWEST BLVD STE C",
            "city": "COEUR D ALENE",
            "state": "ID",
            "postal_code": "838142114",
            "telephone_number": "208-930-1740",
            "fax_number": "208-930-1695"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1044 NORTHWEST BLVD STE C",
            "city": "COEUR D ALENE",
            "state": "ID",
            "postal_code": "838142114",
            "telephone_number": "208-930-1740",
            "fax_number": "208-930-1695"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "AMBITIONS OF IDAHO, INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2009-12-11",
        "last_updated": "2023-10-12",
        "certification_date": "2023-10-12",
        "status": "A",
        "authorized_official_last_name": "HAGEL",
        "authorized_official_first_name": "SHANE",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "208-930-1740"
    },
    "taxonomies": [
        {
            "code": "251B00000X",
            "taxonomy_group": "",
            "desc": "Case Management",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261QM0801X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Mental Health (Including Community Mental Health Center)",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "261QM0850X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Adult Mental Health",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "320900000X",
            "taxonomy_group": "",
            "desc": "Community Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "101YP2500X",
            "taxonomy_group": "",
            "desc": "Counselor, Professional",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "2084P0804X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Child & Adolescent Psychiatry",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "251S00000X",
            "taxonomy_group": "",
            "desc": "Community/Behavioral Health",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "8079051",
            "state": "ID"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Ambitions",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Ambitions",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Coeur d'Alene, ID

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 12, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.