NPIMap

Organization Active NPI

Idahodhwbh3 Caldwell CMH PSR

  • Rehabilitation Clinic/Center
  • Caldwell, ID
National Provider Identifier
1063540359
Registry record updated Aug 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Rehabilitation Clinic/CenterTaxonomy code 261QR0400X
Legal business name
IDAHODHWBH3 CALDWELL CMH PSR
Practice address
3402 Franklin Rd
Caldwell, ID 83605-6932
Phone
(208) 459-0092
Fax
(208) 454-7714
NPI assigned
Mar 1, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 22, 2020

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

Authorized official

Name
Mr. Todd L Hurt, M.S.
Title
Field Operations Manager
Phone
(208) 455-7057

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Rehabilitation Clinic/Center 261QR0400X Primary

Addresses

Primary practice location

3402 Franklin Rd
Caldwell, ID 83605-6932

Mailing address

3402 Franklin Rd
Caldwell, ID 83605-6932
Phone (208) 459-0092

Other identifiers 3

IdentifierTypeStateIssuer
0028416MedicaidID
000010018824OtherBLUESHIELD
HW348OtherBLUE CROSS OF IDAHO

National Provider Directory

National Provider Directory
Tax ID family
Reg VI Mental Health Ctr114 organizations share this tax ID, including this one

Organizations with this tax ID in the same state 18

This tax ID family is large, so up to 24 of its organizations in the same state are linked here.

View all 18

Locations

3402 Franklin Rd
Caldwell, ID 83605
Phone (208) 455-7000

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1172707200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1063540359",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3402 FRANKLIN RD",
            "city": "CALDWELL",
            "state": "ID",
            "postal_code": "836056932",
            "telephone_number": "208-459-0092",
            "fax_number": "208-454-7714"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3402 FRANKLIN RD",
            "city": "CALDWELL",
            "state": "ID",
            "postal_code": "836056932",
            "telephone_number": "208-459-0092",
            "fax_number": "208-454-7714"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "IDAHODHWBH3 CALDWELL CMH PSR",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-03-01",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "HURT",
        "authorized_official_first_name": "TODD",
        "authorized_official_middle_name": "L",
        "authorized_official_title_or_position": "FIELD OPERATIONS MANAGER",
        "authorized_official_telephone_number": "208-455-7057",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "M.S."
    },
    "taxonomies": [
        {
            "code": "261QR0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rehabilitation",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0028416",
            "state": "ID"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUESHIELD",
            "identifier": "000010018824",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS OF IDAHO",
            "identifier": "HW348",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Caldwell, ID

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; 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.