NPIMap

Organization Active NPI

Ambitions of Idaho, Inc.

  • Mental Health Clinic/Center (Including Community Mental Health Center)
  • Coeur d'Alene, ID
National Provider Identifier
1689133050
Registry record updated Mar 15, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Mental Health Clinic/Center (Including Community Mental Health Center)Taxonomy code 261QM0801X
Legal business name
AMBITIONS OF IDAHO, INC.
Practice address
1044 Northwest Blvd Ste F
Coeur D Alene, ID 83814-2165
Phone
(208) 676-9395
Fax
(208) 676-9385
NPI assigned
Mar 15, 2019
Last updated
Mar 15, 2019By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 15, 2019

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

Authorized official

Name
Shane Hagel
Title
President
Phone
(208) 676-9395

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Mental Health Clinic/Center (Including Community Mental Health Center) 261QM0801X Primary

Addresses

Primary practice location

1044 Northwest Blvd Ste F
Coeur D Alene, ID 83814-2165

Mailing address

1044 Northwest Blvd Ste F
Coeur D Alene, ID 83814-2165
Phone (208) 676-9395

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in ID

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20170314000619 ID Part B Supplier - Clinic/Group Practice 6305121328 Receives reassigned benefits from 9 practitioners
1 other NPI on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Coeur D Alene, ID

Other NPIs on the same Medicare enrollment 1

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

National Provider Directory

National Provider Directory
Tax ID family
Ambitions of Idaho Inc5 organizations share this tax ID, including this one

Other organizations with this tax ID 4

Organizations that report the same tax identification number in the National Provider Directory.

Locations

1038 Northwest Blvd
#100
Coeur D Alene, ID 83814
Phone (208) 755-9512

1044 Northwest Blvd
Ste F
Coeur D Alene, ID 83814
Phone (208) 676-9385

3017 S Meridian Rd
Meridian, ID 83642
Phone (208) 888-6123

378 Falls Ave
Twin Falls, ID 83301
Phone (208) 293-8062

Practitioners & affiliated clinicians

Practitioners 16

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.

View all 16

NPI Registry JSON

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

{
    "created_epoch": "1552608000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1552608000000",
    "number": "1689133050",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1044 NORTHWEST BLVD STE F",
            "city": "COEUR D ALENE",
            "state": "ID",
            "postal_code": "838142165",
            "telephone_number": "208-676-9395",
            "fax_number": "208-676-9385"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1044 NORTHWEST BLVD STE F",
            "city": "COEUR D ALENE",
            "state": "ID",
            "postal_code": "838142165",
            "telephone_number": "208-676-9395",
            "fax_number": "208-676-9385"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "AMBITIONS OF IDAHO, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2019-03-15",
        "last_updated": "2019-03-15",
        "status": "A",
        "authorized_official_last_name": "HAGEL",
        "authorized_official_first_name": "SHANE",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "208-676-9395"
    },
    "taxonomies": [
        {
            "code": "261QM0801X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Mental Health (Including Community Mental Health Center)",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Coeur d'Alene, ID

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 15, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.