NPIMap

Organization Active NPI

Independent Growth

  • Case Management Agency
  • Burley, ID
National Provider Identifier
1790997955
Registry record updated Jul 21, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Case Management AgencyTaxonomy code 251B00000X
Legal business name
INDEPENDENT GROWTH
Practice address
2173 Overland Ave
Box 756
Burley, ID 83318-2927
Phone
(208) 678-9165
Fax
(208) 679-5985
NPI assigned
May 3, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 21, 2022

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

Authorized official

Name
Lynda Brennen
Title
Owner
Phone
(208) 678-9165

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Case Management Agency 251B00000X ID Primary

Addresses

Primary practice location

2173 Overland Ave
Box 756
Burley, ID 83318-2927

Mailing address

PO Box 756
Burley, ID 83318-0756
Phone (208) 678-9165

Other identifiers 2

IdentifierTypeStateIssuer
0027664MedicaidID
0027665MedicaidID

National Provider Directory

National Provider Directory

Locations

2173 Overland Ave
#756
Burley, ID 83318
Phone (208) 678-9165

NPI Registry JSON

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

{
    "created_epoch": "1178150400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1658361600000",
    "number": "1790997955",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 756",
            "city": "BURLEY",
            "state": "ID",
            "postal_code": "833180756",
            "telephone_number": "208-678-9165",
            "fax_number": "208-679-5985"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2173 OVERLAND AVE",
            "address_2": "BOX 756",
            "city": "BURLEY",
            "state": "ID",
            "postal_code": "833182927",
            "telephone_number": "208-678-9165",
            "fax_number": "208-679-5985"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "INDEPENDENT GROWTH",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-05-03",
        "last_updated": "2022-07-21",
        "status": "A",
        "authorized_official_last_name": "BRENNEN",
        "authorized_official_first_name": "LYNDA",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "208-678-9165"
    },
    "taxonomies": [
        {
            "code": "251B00000X",
            "taxonomy_group": "",
            "desc": "Case Management",
            "state": "ID",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0027664",
            "state": "ID"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0027665",
            "state": "ID"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Burley, ID

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 21, 2022; 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.