NPIMap

Organization Active NPI

Idaho Dept of Health & Welfare Reg 1 Amh CM Cda

  • Case Management Agency
  • Coeur D Alene, ID
National Provider Identifier
1801923677
Registry record updated Aug 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Case Management AgencyTaxonomy code 251B00000X
Legal business name
IDAHO DEPT OF HEALTH & WELFARE REG 1 AMH CM CDA
Practice address
2195 Ironwood CT
Coeur D Alene, ID 83814-2628
Phone
(208) 769-1406
Fax
(208) 769-1430
NPI assigned
Feb 27, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 22, 2020

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

Authorized official

Name
Cora Jo Gussenhoven
Title
Program Manager
Phone
(208) 769-1406

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Case Management Agency 251B00000X Primary

Addresses

Primary practice location

2195 Ironwood CT
Coeur D Alene, ID 83814-2628

Mailing address

2195 Ironwood CT
Coeur D Alene, ID 83814-2628
Phone (208) 769-1406

Other identifiers 1

IdentifierTypeStateIssuer
0028455MedicaidID

National Provider Directory

National Provider Directory
Tax ID family
Reg VI Mental Health Ctr114 organizations share this tax ID, including this one

Organizations with this tax ID in the same state 24

This tax ID family is large, so up to 24 of its organizations in the same state are linked here.

View all 24

NPI Registry JSON

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

{
    "created_epoch": "1172534400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1801923677",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2195 IRONWOOD CT",
            "city": "COEUR D ALENE",
            "state": "ID",
            "postal_code": "838142628",
            "telephone_number": "208-769-1406",
            "fax_number": "208-769-1430"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2195 IRONWOOD CT",
            "city": "COEUR D ALENE",
            "state": "ID",
            "postal_code": "838142628",
            "telephone_number": "208-769-1406",
            "fax_number": "208-769-1430"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "IDAHO DEPT OF HEALTH & WELFARE REG 1 AMH CM CDA",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-02-27",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "GUSSENHOVEN",
        "authorized_official_first_name": "CORA JO",
        "authorized_official_title_or_position": "PROGRAM MANAGER",
        "authorized_official_telephone_number": "208-769-1406"
    },
    "taxonomies": [
        {
            "code": "251B00000X",
            "taxonomy_group": "",
            "desc": "Case Management",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0028455",
            "state": "ID"
        }
    ],
    "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 Aug 22, 2020; 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.