Idaho Dept of Health & Welfare Amh PSR Mt Home
Organization Active NPI Mental Health Clinic/Center (Including Community Mental Health Center) · Mountain Home, ID
NPI 1720118904 · NPPES record last updated Aug 22, 2020
Key facts
- NPI
- 1720118904
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Mental Health Clinic/Center (Including Community Mental Health Center) 261QM0801X
- Legal business name
- IDAHO DEPT OF HEALTH & WELFARE AMH PSR MT HOME
- Practice address
- 2420 American Legion Blvd
Mountain Home, ID 83647-3146 - Phone
- (208) 587-9061
- Fax
- (208) 587-5024
- NPI assigned
- Mar 6, 2007
- Organization subpart
- No
Authorized official
- Name
- Gina Westcott, M.A.
- Title
- Program Manager
- Phone
- (208) 334-0969
Corporate family (same tax ID) 24
National Provider Directory
- Tax ID family
- Reg VI Mental Health Ctr
Locations
1720 N Westgate Dr
Ste B1
Boise, ID 83704
Phone (208) 334-0894
2420 American Legion Blvd
Mountain Home, ID 83647
Phone (208) 580-9525
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Mental Health Clinic/Center (Including Community Mental Health Center) | 261QM0801X | Yes |
Addresses
Primary practice location
2420 American Legion Blvd
Mountain Home, ID 83647-3146
Mailing address
1720 Westgate Dr
Suite B-1
Boise, ID 83704-7164
Phone (208) 334-0894
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 8073418 | Medicaid | ID | |
| 000010018973 | Other | BLUE SHIELD | |
| HW280 | Other | BLUE CROSS OF IDAHO |
Other providers in Mountain Home, ID
- HSC Dental LLC
- Justin Robert Humber
- Donna M Hunter
- Idaho Behavioral Health, Inc.
- Idaho Dept of Health & Welfare Amh Clinic MH
- Inspiring Change, Inc
- Deborah Jackson
- Jeff Jausoro
- Barry Edward Jenks
- John E. Goodrich, D.D.S.
All providers in Mountain Home, ID · Mental Health Clinic/Center (Including Community Mental Health Center) in Idaho
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Aug 22, 2020. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.