Idaho Dept of Health & Welfare Reg 1 Amh Clinic Cda
Organization Active NPI Adult Mental Health Clinic/Center · Coeur D Alene, ID
NPI 1831226547 · NPPES record last updated Aug 22, 2020
Key facts
- NPI
- 1831226547
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Adult Mental Health Clinic/Center 261QM0850X
- Legal business name
- IDAHO DEPT OF HEALTH & WELFARE REG 1 AMH CLINIC CDA
- Practice address
- 2195 Ironwood CT
Coeur D Alene, ID 83814-2628 - Phone
- (208) 769-1406
- Fax
- (208) 769-1430
- NPI assigned
- Feb 28, 2007
- Organization subpart
- No
Authorized official
- Name
- Cora Jo Gussenhoven
- Title
- Program Manager
- Phone
- (208) 769-1406
Corporate family (same tax ID) 21
National Provider Directory
- Tax ID family
- Reg VI Mental Health Ctr
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Adult Mental Health Clinic/Center | 261QM0850X | Yes |
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
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 000010018348 | Other | BLUE SHIELD | |
| 8073574 | Medicaid | ID | |
| HW256 | Other | BLUE CROSS OF IDAHO |
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All providers in Coeur D Alene, ID · Adult Mental Health Clinic/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.