Proventures LLC

Primary specialty

Community/Behavioral Health AgencyTaxonomy code 251S00000X

Legal business name

PROVENTURES LLC

Practice address

1422 E 17TH St
Suite a
Idaho Falls, ID 83404-6285

Phone

(208) 419-5110

NPI assigned

Apr 9, 2013

Organization subpart

No

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

Authorized official

Name

Patrick Duffin

Title

General Manager/Administrator

Phone

(208) 419-5110

Specialties & licenses 1

Addresses

Other names 1

• Side by Side Family Services Doing business as

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

{
    "created_epoch": "1365465600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1365465600000",
    "number": "1669815726",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6302 E SHARPTAIL RD",
            "city": "IDAHO FALLS",
            "state": "ID",
            "postal_code": "834015922",
            "telephone_number": "208-419-5110"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1422 E 17TH ST",
            "address_2": "SUITE A",
            "city": "IDAHO FALLS",
            "state": "ID",
            "postal_code": "834046285",
            "telephone_number": "208-419-5110"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PROVENTURES LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2013-04-09",
        "last_updated": "2013-04-09",
        "status": "A",
        "authorized_official_last_name": "DUFFIN",
        "authorized_official_first_name": "PATRICK",
        "authorized_official_title_or_position": "GENERAL MANAGER/ADMINISTRATOR",
        "authorized_official_telephone_number": "208-419-5110"
    },
    "taxonomies": [
        {
            "code": "251S00000X",
            "taxonomy_group": "",
            "desc": "Community/Behavioral Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Side by Side Family Services",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• Katherine Ann Puckett, BS, SIT

• Community/Behavioral Health Agency in Idaho Falls, ID
• Providers in Idaho Falls, ID by specialty
• Community/Behavioral Health Agency in Idaho

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 9, 2013; 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.