Teton Supported Living LLC

Primary specialty

Developmentally Disabled Services Day Training AgencyTaxonomy code 251C00000X

Legal business name

TETON SUPPORTED LIVING LLC

Practice address

4101 N Creswell Way
Boise, ID 83713-2404

Phone

(208) 377-0580

Fax

(208) 672-1388

NPI assigned

Apr 10, 2017

Organization subpart

No

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

Authorized official

Name

Jodi L Copeland, BSW

Title

Owner/Administrator

Phone

(208) 377-0580

Specialties & licenses 1

Addresses

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

{
    "created_epoch": "1491782400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1491782400000",
    "number": "1477086114",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4101 N CRESWELL WAY",
            "city": "BOISE",
            "state": "ID",
            "postal_code": "837132404",
            "telephone_number": "208-377-0580",
            "fax_number": "208-672-1388"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4101 N CRESWELL WAY",
            "city": "BOISE",
            "state": "ID",
            "postal_code": "837132404",
            "telephone_number": "208-377-0580",
            "fax_number": "208-672-1388"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "TETON SUPPORTED LIVING LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2017-04-10",
        "last_updated": "2017-04-10",
        "status": "A",
        "authorized_official_last_name": "COPELAND",
        "authorized_official_first_name": "JODI",
        "authorized_official_middle_name": "L",
        "authorized_official_title_or_position": "OWNER/ADMINISTRATOR",
        "authorized_official_telephone_number": "208-377-0580",
        "authorized_official_credential": "BSW"
    },
    "taxonomies": [
        {
            "code": "251C00000X",
            "taxonomy_group": "",
            "desc": "Day Training, Developmentally Disabled Services",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Ariel Terry
• Linda S Terry, LPC, LAMFT
• Mynley Terry
• Beruk Welderufael Tesfamariam Sr.
• Barbara J Tesnohlidek, MD
• Delaney Teuber
• Tracy Joanne Tew, LPN
• Phyllis D Tezeno-Burris, NP
• Sky Blue Thacker, P.T.
• Dillon Tuan Thai, PHARMD

• Developmentally Disabled Services Day Training Agency in Boise, ID
• Providers in Boise, ID by specialty
• Developmentally Disabled Services Day Training Agency in Idaho

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 10, 2017; 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.