NPIMap

Organization Active NPI

Idaho Dept of Health & Welfare Reg 1 Amh PSR St Maries

  • Mental Health Clinic/Center (Including Community Mental Health Center)
  • St Maries, ID
National Provider Identifier
1144357369
Registry record updated Aug 22, 2020
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
IDAHO DEPT OF HEALTH & WELFARE REG 1 AMH PSR ST MARIES
Practice address
222 S 7TH St
St Maries, ID 83861-1847
Phone
(208) 245-2541
Fax
(208) 245-7131
NPI assigned
Feb 27, 2007
Last updated
Aug 22, 2020By the provider in NPPES
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
Cora Jo Gussenhoven
Title
Program Manager
Phone
(208) 769-1406

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Mental Health Clinic/Center (Including Community Mental Health Center) 261QM0801X Primary

Addresses

Primary practice location

222 S 7TH St
St Maries, ID 83861-1847

Mailing address

PO Box 248
St Maries, ID 83861-0248
Phone (208) 245-2541

Other identifiers 3

IdentifierTypeStateIssuer
000010018348OtherBLUE SHIELD
HW256OtherBLUE CROSS OF IDAHO
8073519MedicaidID

National Provider Directory

National Provider Directory
Tax ID family
Idaho Dept of Health Welfare Reg II Amh Grangeville114 organizations share this tax ID, including this one

Organizations with this tax ID in the same state 23

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

View all 23

NPI Registry JSON

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

{
    "created_epoch": "1172534400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1144357369",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 248",
            "city": "ST MARIES",
            "state": "ID",
            "postal_code": "838610248",
            "telephone_number": "208-245-2541",
            "fax_number": "208-245-7131"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "222 S 7TH ST",
            "city": "ST MARIES",
            "state": "ID",
            "postal_code": "838611847",
            "telephone_number": "208-245-2541",
            "fax_number": "208-245-7131"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "IDAHO DEPT OF HEALTH & WELFARE REG 1 AMH PSR ST MARIES",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-02-27",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "GUSSENHOVEN",
        "authorized_official_first_name": "CORA JO",
        "authorized_official_title_or_position": "PROGRAM MANAGER",
        "authorized_official_telephone_number": "208-769-1406"
    },
    "taxonomies": [
        {
            "code": "261QM0801X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Mental Health (Including Community Mental Health Center)",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE SHIELD",
            "identifier": "000010018348",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS OF IDAHO",
            "identifier": "HW256",
            "state": null
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "8073519",
            "state": "ID"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in St Maries, 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.