NPIMap

Organization Active NPI

Idaho Dept of Health & Welfare Reg 1 CMH PSR Cda

  • Rehabilitation Clinic/Center
  • Coeur D Alene, ID
National Provider Identifier
1164550455
Registry record updated Aug 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Rehabilitation Clinic/CenterTaxonomy code 261QR0400X
Legal business name
IDAHO DEPT OF HEALTH & WELFARE REG 1 CMH PSR CDA
Practice address
1250 Ironwood Dr Ste 100
Coeur D Alene, ID 83814-2628
Phone
(208) 769-1515
Fax
(208) 666-6744
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
Cora Jo Gussenhoven
Title
Program Manager
Phone
(208) 769-1406

Specialties & licenses 1

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

Addresses

Primary practice location

1250 Ironwood Dr Ste 100
Coeur D Alene, ID 83814-2628

Mailing address

1250 Ironwood Dr Ste 100
Coeur D Alene, ID 83814-2628
Phone (208) 769-1515

Other identifiers 3

IdentifierTypeStateIssuer
HW199OtherBLUE CROSS OF IDAHO
000010018348OtherBLUE SHIELD
0028408MedicaidID

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 24

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

View all 24

Locations

1250 W Ironwood Dr
Ste 100
Coeur D Alene, ID 83814
Phone (208) 769-1515

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": "1164550455",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1250 IRONWOOD DR STE 100",
            "city": "COEUR D ALENE",
            "state": "ID",
            "postal_code": "838142628",
            "telephone_number": "208-769-1515",
            "fax_number": "208-666-6744"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1250 IRONWOOD DR STE 100",
            "city": "COEUR D ALENE",
            "state": "ID",
            "postal_code": "838142628",
            "telephone_number": "208-769-1515",
            "fax_number": "208-666-6744"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "IDAHO DEPT OF HEALTH & WELFARE REG 1 CMH PSR CDA",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-03-01",
        "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": "261QR0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rehabilitation",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS OF IDAHO",
            "identifier": "HW199",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE SHIELD",
            "identifier": "000010018348",
            "state": null
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0028408",
            "state": "ID"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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 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.