Idaho Dhwbh3 Caldamhclinic

Organization Active NPI Adult Mental Health Clinic/Center · Caldwell, ID

NPI 1700913340 · NPPES record last updated Aug 22, 2020

Key facts

NPI
1700913340
Entity type
Organization (NPI type 2)
Primary specialty
Adult Mental Health Clinic/Center 261QM0850X
Legal business name
IDAHO DHWBH3 CALDAMHCLINIC
Practice address
3402 Franklin Rd
Caldwell, ID 83605-6932
Phone
(208) 459-0092
Fax
(208) 454-7714
NPI assigned
Feb 28, 2007
Organization subpart
No

Authorized official

Name
Mr. Todd L Hurt, M.S.
Title
Field Operations Manager
Phone
(208) 455-7057

Corporate family (same tax ID) 24

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

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

National Provider Directory

Tax ID family
Reg VI Mental Health Ctr (114 organizations share this tax ID)

Specialties & licenses

Specialty (taxonomy)CodeLicenseStatePrimary
Adult Mental Health Clinic/Center 261QM0850X Yes

Addresses

Primary practice location

3402 Franklin Rd
Caldwell, ID 83605-6932

Mailing address

3402 Franklin Rd
Caldwell, ID 83605-6932
Phone (208) 459-0092

Other identifiers

IdentifierTypeStateIssuer
HW298OtherIDBLUE CROSS OF IDAHO
000010027633OtherIDBLUESHIELD
8062827MedicaidID

Other providers in Caldwell, ID

All providers in Caldwell, ID · Adult Mental Health Clinic/Center in Idaho

Sources for this page

Verify at the official NPI Registry.