NPIMap

Organization Active NPI

Progressive Behavior Services

  • Developmentally Disabled Services Day Training Agency
  • Boise, ID
National Provider Identifier
1649487638
Registry record updated Oct 16, 2009
On this page

Key facts

NPPES NPI Registry
Primary specialty
Developmentally Disabled Services Day Training AgencyTaxonomy code 251C00000X
Legal business name
PROGRESSIVE BEHAVIOR SERVICES
Practice address
9424 W Fairview Ave
Boise, ID 83704-8101
Phone
(208) 375-3888
Fax
(208) 375-9444
NPI assigned
May 17, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 16, 2009

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

Authorized official

Name
Mark Wiseman, LPC
Title
Owner
Phone
(208) 919-9706

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Developmentally Disabled Services Day Training Agency 251C00000X Primary

Addresses

Primary practice location

9424 W Fairview Ave
Boise, ID 83704-8101

Mailing address

3321 S Stanford St
Nampa, ID 83686-8292
Phone (208) 919-9706

Other identifiers 1

IdentifierTypeStateIssuer
807381600MedicaidID

National Provider Directory

National Provider Directory
Tax ID family
Progressive Behavior Services6 organizations share this tax ID, including this one

Other organizations with this tax ID 5

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": "1179360000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1255651200000",
    "number": "1649487638",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3321 S STANFORD ST",
            "city": "NAMPA",
            "state": "ID",
            "postal_code": "836868292",
            "telephone_number": "208-919-9706"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9424 W FAIRVIEW AVE",
            "city": "BOISE",
            "state": "ID",
            "postal_code": "837048101",
            "telephone_number": "208-375-3888",
            "fax_number": "208-375-9444"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PROGRESSIVE BEHAVIOR SERVICES",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-05-17",
        "last_updated": "2009-10-16",
        "status": "A",
        "authorized_official_last_name": "WISEMAN",
        "authorized_official_first_name": "MARK",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "208-919-9706",
        "authorized_official_credential": "LPC"
    },
    "taxonomies": [
        {
            "code": "251C00000X",
            "taxonomy_group": "",
            "desc": "Day Training, Developmentally Disabled Services",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "807381600",
            "state": "ID"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Boise, ID

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 16, 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.