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Organization Active NPI

Idaho Dept of Health & Welfare Reg II Amh Lew. Clinic

  • Adult Mental Health Clinic/Center
  • Lewiston, ID
National Provider Identifier
1811025406
Registry record updated Aug 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Adult Mental Health Clinic/CenterTaxonomy code 261QM0850X
Legal business name
IDAHO DEPT OF HEALTH & WELFARE REG II AMH LEW. CLINIC
Practice address
1118 F St
Lewiston, ID 83501-1930
Phone
(208) 799-4440
Fax
(208) 799-5171
NPI assigned
Mar 2, 2007
Last updated
Aug 22, 2020By the provider in NPPES
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
Vicki R. Malone, MSW
Title
Program Manager
Phone
(208) 799-4440

Specialties & licenses 1

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

Addresses

Primary practice location

1118 F St
Lewiston, ID 83501-1930

Mailing address

1118 F St
Drawer B
Lewiston, ID 83501-1930
Phone (208) 799-4440

Other identifiers 3

IdentifierTypeStateIssuer
HW264OtherBLUE CROSS OF IDAHO
000010018440OtherBLUE SHIELD
0028329MedicaidID

National Provider Directory

National Provider Directory
Tax ID family
Idaho Dept of Health Welfare Reg II Amh Grangeville114 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": "1172793600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1811025406",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1118 F ST",
            "address_2": "DRAWER B",
            "city": "LEWISTON",
            "state": "ID",
            "postal_code": "835011930",
            "telephone_number": "208-799-4440",
            "fax_number": "208-799-5171"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1118 F ST",
            "city": "LEWISTON",
            "state": "ID",
            "postal_code": "835011930",
            "telephone_number": "208-799-4440",
            "fax_number": "208-799-5171"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "IDAHO DEPT OF HEALTH & WELFARE REG II AMH LEW. CLINIC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-03-02",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "MALONE",
        "authorized_official_first_name": "VICKI",
        "authorized_official_middle_name": "R.",
        "authorized_official_title_or_position": "PROGRAM MANAGER",
        "authorized_official_telephone_number": "208-799-4440",
        "authorized_official_credential": "MSW"
    },
    "taxonomies": [
        {
            "code": "261QM0850X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Adult Mental Health",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS OF IDAHO",
            "identifier": "HW264",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE SHIELD",
            "identifier": "000010018440",
            "state": null
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0028329",
            "state": "ID"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Lewiston, 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.