NPIMap

Organization Active NPI

Idaho Dept of Health & Welfare Reg 1 Amh Clinic Sandpoint

  • Adult Mental Health Clinic/Center
  • Ponderay, ID
National Provider Identifier
1467589184
Registry record updated Aug 25, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Adult Mental Health Clinic/CenterTaxonomy code 261QM0850X
Legal business name
IDAHO DEPT OF HEALTH & WELFARE REG 1 AMH CLINIC SANDPOINT
Practice address
207 Larkspur St
Ponderay, ID 83852-5011
Phone
(208) 265-4535
Fax
(208) 263-4198
NPI assigned
Feb 28, 2007
Last updated
Aug 25, 2016By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 25, 2016

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

Authorized official

Name
Holly Bonwell
Title
Program Manager
Phone
(208) 769-1406

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Adult Mental Health Clinic/Center 261QM0850X NU Primary

Addresses

Primary practice location

207 Larkspur St
Ponderay, ID 83852-5011

Mailing address

207 Larkspur St
Ponderay, ID 83852-5011
Phone (208) 265-4535

Other identifiers 3

IdentifierTypeStateIssuer
000010018348OtherBLUE SHIELD
8073679MedicaidID
HW256OtherBLUE CROSS OF IDAHO

National Provider Directory

National Provider Directory
Tax ID family
Idaho Dept of Health Welfare Reg II Amh Grangeville114 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

207 Larkspur St
Ponderay, ID 83852
Phone (208) 255-3304

Practitioners & affiliated clinicians

Practitioners 7

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

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": "1472083200000",
    "number": "1467589184",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "207 LARKSPUR ST",
            "city": "PONDERAY",
            "state": "ID",
            "postal_code": "838525011",
            "telephone_number": "208-265-4535",
            "fax_number": "208-263-4198"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "207 LARKSPUR ST",
            "city": "PONDERAY",
            "state": "ID",
            "postal_code": "838525011",
            "telephone_number": "208-265-4535",
            "fax_number": "208-263-4198"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "IDAHO DEPT OF HEALTH & WELFARE REG 1 AMH CLINIC SANDPOINT",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-02-28",
        "last_updated": "2016-08-25",
        "status": "A",
        "authorized_official_last_name": "BONWELL",
        "authorized_official_first_name": "HOLLY",
        "authorized_official_title_or_position": "PROGRAM MANAGER",
        "authorized_official_telephone_number": "208-769-1406"
    },
    "taxonomies": [
        {
            "code": "261QM0850X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Adult Mental Health",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE SHIELD",
            "identifier": "000010018348",
            "state": null
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "8073679",
            "state": "ID"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS OF IDAHO",
            "identifier": "HW256",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Ponderay, ID

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 25, 2016; 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.