NPIMap

Organization Active NPI

Ashton Memorial Inc

Doing business as Gustafson House

  • Emotionally Disturbed Childrens' Residential Treatment Facility
  • Idaho Falls, ID
National Provider Identifier
1104665587
Registry record updated May 23, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Emotionally Disturbed Childrens' Residential Treatment FacilityTaxonomy code 322D00000X
Legal business name
ASHTON MEMORIAL INC
Doing business as
Gustafson House
Practice address
2935 Rollandet St
Idaho Falls, ID 83402-4654
Phone
(208) 542-2905
Fax
(208) 522-2427
NPI assigned
May 23, 2024
Last updated
May 23, 2024By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 23, 2024

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

Authorized official

Name
Suzanne Brady
Title
HR Director/Compliance Officer
Phone
(208) 652-7461

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Emotionally Disturbed Childrens' Residential Treatment Facility 322D00000X Primary

Addresses

Primary practice location

2935 Rollandet St
Idaho Falls, ID 83402-4654

Mailing address

PO Box 838
Ashton, ID 83420-0838
Phone (208) 652-7461

Other names 1

  • Gustafson House Doing business as

National Provider Directory

National Provider Directory
Tax ID family
Ashton Memorial Inc4 organizations share this tax ID, including this one

Other organizations with this tax ID 3

Organizations that report the same tax identification number in the 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": "1716422400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1716422400000",
    "number": "1104665587",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 838",
            "city": "ASHTON",
            "state": "ID",
            "postal_code": "834200838",
            "telephone_number": "208-652-7461",
            "fax_number": "208-652-7595"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2935 ROLLANDET ST",
            "city": "IDAHO FALLS",
            "state": "ID",
            "postal_code": "834024654",
            "telephone_number": "208-542-2905",
            "fax_number": "208-522-2427"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ASHTON MEMORIAL INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2024-05-23",
        "last_updated": "2024-05-23",
        "certification_date": "2024-05-23",
        "status": "A",
        "authorized_official_last_name": "BRADY",
        "authorized_official_first_name": "SUZANNE",
        "authorized_official_title_or_position": "HR DIRECTOR/COMPLIANCE OFFICER",
        "authorized_official_telephone_number": "208-652-7461"
    },
    "taxonomies": [
        {
            "code": "322D00000X",
            "taxonomy_group": "",
            "desc": "Residential Treatment Facility, Emotionally Disturbed Children",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Gustafson House",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Idaho Falls, ID

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 23, 2024; 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.