NPIMap

Organization Active NPI

Idaho Dept of Health & Welfare Reg 1 Amh PSR Bonners Ferry

  • Mental Health Clinic/Center (Including Community Mental Health Center)
  • Bonners Ferry, ID
National Provider Identifier
1376670091
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 BONNERS FERRY
Practice address
RT 4 6522 Tamarack LN
Bonners Ferry, ID 83805-9805
Phone
(208) 267-3187
Fax
(208) 267-3251
NPI assigned
Feb 28, 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
Mental Health Clinic/Center (Including Community Mental Health Center) 261QM0801X Primary

Addresses

Primary practice location

RT 4 6522 Tamarack LN
Bonners Ferry, ID 83805-9805

Mailing address

RT 4 6522 Tamarack LN
Bonners Ferry, ID 83805-9805
Phone (208) 267-3187

Other identifiers 3

IdentifierTypeStateIssuer
8073521MedicaidID
000010018348OtherBLUE SHIELD
HW256OtherBLUE CROSS OF IDAHO

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

6543 Main St
Bonners Ferry, ID 83805
Phone (208) 267-3187

NPI Registry JSON

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

{
    "created_epoch": "1172620800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1376670091",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "RT 4 6522 TAMARACK LN",
            "city": "BONNERS FERRY",
            "state": "ID",
            "postal_code": "838059805",
            "telephone_number": "208-267-3187",
            "fax_number": "208-267-3251"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "RT 4 6522 TAMARACK LN",
            "city": "BONNERS FERRY",
            "state": "ID",
            "postal_code": "838059805",
            "telephone_number": "208-267-3187",
            "fax_number": "208-267-3251"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "IDAHO DEPT OF HEALTH & WELFARE REG 1 AMH PSR BONNERS FERRY",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-02-28",
        "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": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "8073521",
            "state": "ID"
        },
        {
            "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
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Bonners Ferry, 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.