NPIMap

Organization Active NPI

Human Supports of Idaho, Inc.

  • Case Management Agency
  • Caldwell, ID
National Provider Identifier
1376686949
Registry record updated Sep 30, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
Case Management AgencyTaxonomy code 251B00000X
Legal business name
HUMAN SUPPORTS OF IDAHO, INC.
Practice address
314 Badiola St
Caldwell, ID 83605-4389
Phone
(208) 454-8389
Fax
(208) 454-8404
NPI assigned
Feb 14, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 30, 2013

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

Authorized official

Name
Gregory L Dickerson, LMSW
Title
Administrator
Phone
(208) 321-0160

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Case Management Agency 251B00000X Primary

Addresses

Primary practice location

314 Badiola St
Caldwell, ID 83605-4389

Mailing address

PO Box 820
Caldwell, ID 83606-0820
Phone (208) 454-8389

Other identifiers 1

IdentifierTypeStateIssuer
002800200MedicaidID

National Provider Directory

National Provider Directory
Tax ID family
Human Supports of Idaho Inc5 organizations share this tax ID, including this one

Other organizations with this tax ID 4

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": "1171411200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1380499200000",
    "number": "1376686949",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 820",
            "city": "CALDWELL",
            "state": "ID",
            "postal_code": "836060820",
            "telephone_number": "208-454-8389",
            "fax_number": "208-454-8404"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "314 BADIOLA ST",
            "city": "CALDWELL",
            "state": "ID",
            "postal_code": "836054389",
            "telephone_number": "208-454-8389",
            "fax_number": "208-454-8404"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "HUMAN SUPPORTS OF IDAHO, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-02-14",
        "last_updated": "2013-09-30",
        "status": "A",
        "authorized_official_last_name": "DICKERSON",
        "authorized_official_first_name": "GREGORY",
        "authorized_official_middle_name": "L",
        "authorized_official_title_or_position": "ADMINISTRATOR",
        "authorized_official_telephone_number": "208-321-0160",
        "authorized_official_credential": "LMSW"
    },
    "taxonomies": [
        {
            "code": "251B00000X",
            "taxonomy_group": "",
            "desc": "Case Management",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "002800200",
            "state": "ID"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Caldwell, ID

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 30, 2013; 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.