East Idaho Youth Homes LLC Dda

Primary specialty

Developmental Disabilities Clinic/CenterTaxonomy code 261QD1600X

Legal business name

EAST IDAHO YOUTH HOMES LLC DDA

Practice address

983 Curlew Dr
Ammon, ID 83406-4706

Phone

(208) 881-9100

NPI assigned

Mar 14, 2023

Organization subpart

Yes

Parent organization

EAST IDAHO YOUTH HOMES LLCAs reported in NPPES

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

Authorized official

Name

Karen Faye Tornkvist

Title

Chief Administrator

Phone

(208) 360-8102

Specialties & licenses 4

Addresses

Part of

East Idaho Youth Homes LLC

Parent organization (reported in NPPES) 1

This organization reports itself as a subpart in NPPES; the parent’s legal name matches this organization in the same state.

• East Idaho Youth Homes LLC

  • Mental Health Counselor
  • Idaho Falls, ID
  • NPI 1306543228
  NPPES parent name

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

{
    "created_epoch": "1678752000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1678752000000",
    "number": "1316648546",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "550 LINDEN DR",
            "city": "IDAHO FALLS",
            "state": "ID",
            "postal_code": "834014149",
            "telephone_number": "208-360-8102"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "983 CURLEW DR",
            "city": "AMMON",
            "state": "ID",
            "postal_code": "834064706",
            "telephone_number": "208-881-9100"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1061 Curlew Dr",
            "address_purpose": "LOCATION",
            "city": "Ammon",
            "state": "ID",
            "postal_code": "834064766",
            "country_code": "US",
            "telephone_number": "208-360-8102",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "EAST IDAHO YOUTH HOMES LLC DDA",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "EAST IDAHO YOUTH HOMES LLC",
        "enumeration_date": "2023-03-14",
        "last_updated": "2023-03-14",
        "certification_date": "2023-03-14",
        "status": "A",
        "authorized_official_last_name": "TORNKVIST",
        "authorized_official_first_name": "KAREN",
        "authorized_official_middle_name": "FAYE",
        "authorized_official_title_or_position": "CHIEF ADMINISTRATOR",
        "authorized_official_telephone_number": "208-360-8102"
    },
    "taxonomies": [
        {
            "code": "103K00000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Behavior Analyst",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "106E00000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Assistant Behavior Analyst",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "106S00000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Behavior Technician",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261QD1600X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Developmental Disabilities",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Spencer Louis Dietz, PHARMD, RPH
• Sean Dixon
• Caylie Mae Dole
• Delaynie Dorsey
• Heidi Duran, DPT
• East Ridge Chiropractic
• Eastern Idaho Medical Supply Company
• Eastgate Drug (Eastgate Drug Store)
• Eiyh Behavioral Health LLC
• Eiyh Icf LLC

• Developmental Disabilities Clinic/Center in Ammon, ID
• Providers in Ammon, ID by specialty
• Developmental Disabilities Clinic/Center in Idaho

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 14, 2023; 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.