Ambitions of Idaho, Inc
Organization Active NPI Mental Health Clinic/Center (Including Community Mental Health Center) · Coeur D Alene, ID
NPI 1003145533 · NPPES record last updated Oct 12, 2023
Key facts
- NPI
- 1003145533
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Mental Health Clinic/Center (Including Community Mental Health Center) 261QM0801X
- Legal business name
- AMBITIONS OF IDAHO, INC
- 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
- Organization subpart
- No
Authorized official
- Name
- Shane Hagel
- Title
- President
- Phone
- (208) 930-1740
Other NPIs on the same Medicare enrollment 1
Practitioners 16
-
Melissa Alton, LCSW
-
Samuel Neal, LPC
-
Jessica Peterson, LCSW
-
Tanya Ryan, LCSW
-
Jeannie Dalton, LCSW
-
Deborah Rodgers, LCSW
-
Morgan Suzanne Bruce, LMSW
-
Sara Gray, M.ED., CADC
-
Ashley N Lisk, LPC
-
John Ryan Palmer, LMSW
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in ID
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| 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 |
National Provider Directory
Locations
1044 Northwest Blvd
Ste C
Coeur D Alene, ID 83814
Phone (208) 667-7777
511 N Argonne Rd
Ste 200
Spokane Valley, WA 99212
Phone (509) 321-0414
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Professional Counselor |
101YP2500X | |||
| Clinical Social Worker |
1041C0700X | |||
| Child & Adolescent Psychiatry Physician |
2084P0804X | |||
| Case Management Agency | 251B00000X | |||
| Community/Behavioral Health Agency | 251S00000X | |||
| Mental Health Clinic/Center (Including Community Mental Health Center) | 261QM0801X | Yes | ||
| Adult Mental Health Clinic/Center | 261QM0850X | |||
| Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility | 320900000X |
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
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 8079051 | Medicaid | ID |
Other names
- Ambitions
Other providers in Coeur D Alene, ID
- Melissa Alton
- Susan Marie Amaral
- Amaris Behavioral Health LLC
- Ambitions of Idaho Inc
- Ambitions of Idaho Inc
- Ambitions of Idaho, Inc.
- Frederick P Ambrose
- Amanda Ament
- America'S Best Contacts & Eyeglasses
- American Mobile Drug Testing / a Drug Free Alliance
All providers in Coeur D Alene, ID · Mental Health Clinic/Center (Including Community Mental Health Center) in Idaho
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Oct 12, 2023. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.