Snake River Community Supported Living

Primary specialty

Community/Behavioral Health AgencyTaxonomy code 251S00000X

Legal business name

SNAKE RIVER COMMUNITY SUPPORTED LIVING

Practice address

557 S Woodruff Ave
Idaho Falls, ID 83401-5200

Phone

(208) 542-4517

NPI assigned

Jun 30, 2014

Organization subpart

No

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

Authorized official

Name

Kathleen Ann Hansen

Title

Owner/Administrator

Phone

(208) 542-4517

Specialties & licenses 1

Addresses

Locations

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

{
    "created_epoch": "1404086400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1404086400000",
    "number": "1851706626",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "557 S WOODRUFF AVE",
            "city": "IDAHO FALLS",
            "state": "ID",
            "postal_code": "834015200",
            "telephone_number": "208-542-4517"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "557 S WOODRUFF AVE",
            "city": "IDAHO FALLS",
            "state": "ID",
            "postal_code": "834015200",
            "telephone_number": "208-542-4517"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SNAKE RIVER COMMUNITY SUPPORTED LIVING",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-06-30",
        "last_updated": "2014-06-30",
        "status": "A",
        "authorized_official_last_name": "HANSEN",
        "authorized_official_first_name": "KATHLEEN",
        "authorized_official_middle_name": "ANN",
        "authorized_official_title_or_position": "OWNER/ADMINISTRATOR",
        "authorized_official_telephone_number": "208-542-4517"
    },
    "taxonomies": [
        {
            "code": "251S00000X",
            "taxonomy_group": "",
            "desc": "Community/Behavioral Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Taylor Drew Smith, MSPH, PA-C
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• Tyson Smithersen, FNP
• Jessica Packer Smoot, PA
• Snake River Counseling Center LLC
• Snake River Family Chiropractic Health and Wellness Center (Snake River Chiropractic)
• Snake River Hearing and Balance LLC
• Snake River Hospitalists, LLC
• Snake River Human Services

• Community/Behavioral Health Agency in Idaho Falls, ID
• Providers in Idaho Falls, ID by specialty
• Community/Behavioral Health Agency in Idaho

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 30, 2014; 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.