NPIMap

Organization Active NPI

Idaho Falls Group Homes

  • Intellectual Disabilities Intermediate Care Facility
  • Ammon, ID
National Provider Identifier
1235333576
Registry record updated Aug 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Intellectual Disabilities Intermediate Care FacilityTaxonomy code 315P00000X
License
29 Issued in ID
Legal business name
IDAHO FALLS GROUP HOMES
Practice address
4360 Wanda St
Ammon, ID 83406-6878
Phone
(208) 522-4614
NPI assigned
Jun 12, 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. Rex Redden
Title
Administrator
Phone
(208) 523-0053

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Intellectual Disabilities Intermediate Care Facility 315P00000X 29 ID Primary

Addresses

Primary practice location

4360 Wanda St
Ammon, ID 83406-6878

Mailing address

PO Box 50457
Idaho Falls, ID 83405-0457

National Provider Directory

National Provider Directory
Tax ID family
Idaho Falls Group Homes4 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.

NPI Registry JSON

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

{
    "created_epoch": "1181606400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1235333576",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 50457",
            "city": "IDAHO FALLS",
            "state": "ID",
            "postal_code": "834050457"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4360 WANDA ST",
            "city": "AMMON",
            "state": "ID",
            "postal_code": "834066878",
            "telephone_number": "208-522-4614"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "IDAHO FALLS GROUP HOMES",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-06-12",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "REDDEN",
        "authorized_official_first_name": "REX",
        "authorized_official_title_or_position": "ADMINISTRATOR",
        "authorized_official_telephone_number": "208-523-0053",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "315P00000X",
            "taxonomy_group": "",
            "desc": "Intermediate Care Facility, Intellectual Disabilities",
            "state": "ID",
            "license": "29",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Ammon, 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.