NPIMap

Organization Active NPI

Childrens Supportive Services Incorporated

  • Community/Behavioral Health Agency
  • Blackfoot, ID
National Provider Identifier
1407074636
Registry record updated Dec 2, 2009
On this page

Key facts

NPPES NPI Registry
Primary specialty
Community/Behavioral Health AgencyTaxonomy code 251S00000X
Legal business name
CHILDRENS SUPPORTIVE SERVICES INCORPORATED
Practice address
625 W Pacific St
Suite 2
Blackfoot, ID 83221-2034
Phone
(208) 524-8996
Fax
(208) 524-1205
NPI assigned
Apr 23, 2007
Last updated
Dec 2, 2009By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 2, 2009

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

Authorized official

Name
Cathie Crane
Title
Secretary-Treasurer
Phone
(208) 524-8996

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Community/Behavioral Health Agency 251S00000X NU Primary

Addresses

Primary practice location

625 W Pacific St
Suite 2
Blackfoot, ID 83221-2034

Mailing address

1565 E Lincoln Rd
Idaho Falls, ID 83401-2129
Phone (208) 524-8996

Other identifiers 1

IdentifierTypeStateIssuer
807354200MedicaidID

National Provider Directory

National Provider Directory
Tax ID family
Childrens Supportive Services Incorporated9 organizations share this tax ID, including this one

Other organizations with this tax ID 8

Organizations that report the same tax identification number in the National Provider Directory.

Locations

625 W Pacific St
Ste 2
Blackfoot, ID 83221
Phone (208) 524-8996

NPI Registry JSON

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

{
    "created_epoch": "1177286400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1259712000000",
    "number": "1407074636",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1565 E LINCOLN RD",
            "city": "IDAHO FALLS",
            "state": "ID",
            "postal_code": "834012129",
            "telephone_number": "208-524-8996",
            "fax_number": "208-524-1205"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "625 W PACIFIC ST",
            "address_2": "SUITE 2",
            "city": "BLACKFOOT",
            "state": "ID",
            "postal_code": "832212034",
            "telephone_number": "208-524-8996",
            "fax_number": "208-524-1205"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CHILDRENS SUPPORTIVE SERVICES INCORPORATED",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-04-23",
        "last_updated": "2009-12-02",
        "status": "A",
        "authorized_official_last_name": "CRANE",
        "authorized_official_first_name": "CATHIE",
        "authorized_official_title_or_position": "SECRETARY-TREASURER",
        "authorized_official_telephone_number": "208-524-8996"
    },
    "taxonomies": [
        {
            "code": "251S00000X",
            "taxonomy_group": "",
            "desc": "Community/Behavioral Health",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "807354200",
            "state": "ID"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Blackfoot, ID

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 2, 2009; 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.