208 Supported Living

Primary specialty

Intellectual and/or Developmental Disabilities Residential Treatment FacilityTaxonomy code 320600000X

Legal business name

208 SUPPORTED LIVING

Practice address

1512 4TH St N
Nampa, ID 83687-4039

Phone

(208) 409-1259

NPI assigned

Oct 27, 2026

Last updated

Oct 27, 2026By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Theodore Mazambi

Title

Governing Authority

Phone

(208) 409-1259

Specialties & licenses 1

Addresses

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

{
    "created_epoch": "1793059200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1793059200000",
    "number": "1629976907",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1512 4TH ST N",
            "city": "NAMPA",
            "state": "ID",
            "postal_code": "836874039",
            "telephone_number": "208-409-1259"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1512 4TH ST N",
            "city": "NAMPA",
            "state": "ID",
            "postal_code": "836874039",
            "telephone_number": "208-409-1259"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "208 SUPPORTED LIVING",
        "organizational_subpart": "NO",
        "enumeration_date": "2026-10-27",
        "last_updated": "2026-10-27",
        "certification_date": "2026-10-27",
        "status": "A",
        "authorized_official_last_name": "MAZAMBI",
        "authorized_official_first_name": "THEODORE",
        "authorized_official_title_or_position": "GOVERNING AUTHORITY",
        "authorized_official_telephone_number": "208-409-1259"
    },
    "taxonomies": [
        {
            "code": "320600000X",
            "taxonomy_group": "",
            "desc": "Residential Treatment Facility, Intellectual and/or Developmental Disabilities",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Intellectual and/or Developmental Disabilities Residential Treatment Facility in Nampa, ID
• Providers in Nampa, ID by specialty
• Intellectual and/or Developmental Disabilities Residential Treatment Facility in Idaho

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 27, 2026; 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.