NPIMap

Organization Active NPI

State of Idaho

  • Intellectual Disabilities Intermediate Care Facility
  • Nampa, ID
National Provider Identifier
1316063787
Registry record updated Aug 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Intellectual Disabilities Intermediate Care FacilityTaxonomy code 315P00000X
License
01 Issued in ID
Legal business name
STATE OF IDAHO
Doing business as
DHW IDAHO STATE SCHOOL AND HOPSITAL
Practice address
1660 11TH Ave N
Nampa, ID 83687-5000
Phone
(208) 442-2812
Fax
(208) 467-5978
NPI assigned
Mar 21, 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
Sue Broetje
Title
Administrative Director
Phone
(208) 442-2812

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Intellectual Disabilities Intermediate Care Facility 315P00000X 01 ID Primary

Addresses

Primary practice location

1660 11TH Ave N
Nampa, ID 83687-5000

Mailing address

1660 11TH Ave N
Nampa, ID 83687-5000
Phone (208) 442-2812

Other names 1

  • DHW IDAHO STATE SCHOOL AND HOPSITAL Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

Intermediate care facility for individuals with intellectual disabilities certification: CCN 13G001

Name & address match This certification has no NPI in the Medicare enrollment files. CMS publishes enrollment files for six facility types only, so it was connected to this NPI by matching the name and address CMS publishes for it.

Legal name
Southwest Idaho Treatment Center
Certification status
Active
Provider type (POS)
Intermediate care facility for individuals with intellectual disabilities
Participating since
Jun 1, 1982
Last certification
May 15, 2025
Beds
18
Ownership / control type
State
Facility address
1660 Eleventh Avenue North
Nampa, ID 83687

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

NPI Registry JSON

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

{
    "created_epoch": "1174435200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1316063787",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1660 11TH AVE N",
            "city": "NAMPA",
            "state": "ID",
            "postal_code": "836875000",
            "telephone_number": "208-442-2812",
            "fax_number": "208-467-5978"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1660 11TH AVE N",
            "city": "NAMPA",
            "state": "ID",
            "postal_code": "836875000",
            "telephone_number": "208-442-2812",
            "fax_number": "208-467-5978"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "STATE OF IDAHO",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-03-21",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "BROETJE",
        "authorized_official_first_name": "SUE",
        "authorized_official_title_or_position": "ADMINISTRATIVE DIRECTOR",
        "authorized_official_telephone_number": "208-442-2812"
    },
    "taxonomies": [
        {
            "code": "315P00000X",
            "taxonomy_group": "",
            "desc": "Intermediate Care Facility, Intellectual Disabilities",
            "state": "ID",
            "license": "01",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "DHW IDAHO STATE SCHOOL AND HOPSITAL",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Nampa, ID

Sources for this page

Verify at the official NPI Registry.