NPIMap

Organization Active NPI

Antelope Creek Assisted Living

  • Assisted Living Facility (Mental Illness)
  • Darlington, ID
National Provider Identifier
1881761476
Registry record updated Dec 24, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Assisted Living Facility (Mental Illness)Taxonomy code 3104A0625X
Legal business name
ANTELOPE CREEK ASSISTED LIVING
Practice address
3668 W. 3700 N.
Darlington, ID 83255-0909
Phone
(208) 588-2700
Fax
(208) 588-2701
NPI assigned
Nov 29, 2006
Last updated
Dec 24, 2025By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 24, 2025

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

Authorized official

Name
Kasey D Borgman
Title
Director of Corp Compliance
Phone
(208) 245-4576

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Assisted Living Facility (Mental Illness) 3104A0625X NU Primary
Assisted Living Facility (Behavioral Disturbances) 3104A0630X NU

Addresses

Primary practice location

3668 W. 3700 N.
Darlington, ID 83255-0909

Mailing address

820 Elm Dr
St Maries, ID 83861-2119
Phone (208) 245-4576

Other identifiers 1

IdentifierTypeStateIssuer
805729800MedicaidID

Other names 1

  • Antelope Creek Assisted Living Other name

National Provider Directory

National Provider Directory
Tax ID family
Antelope Creek Assisted Living20 organizations share this tax ID, including this one

Other organizations with this tax ID 19

Organizations that report the same tax identification number in the National Provider Directory.

View all 19

NPI Registry JSON

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

{
    "created_epoch": "1164758400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1766534400000",
    "number": "1881761476",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "820 ELM DR",
            "city": "ST MARIES",
            "state": "ID",
            "postal_code": "838612119",
            "telephone_number": "208-245-4576",
            "fax_number": "208-245-2138"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3668 W. 3700 N.",
            "city": "DARLINGTON",
            "state": "ID",
            "postal_code": "832550909",
            "telephone_number": "208-588-2700",
            "fax_number": "208-588-2701"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ANTELOPE CREEK ASSISTED LIVING",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-11-29",
        "last_updated": "2025-12-24",
        "certification_date": "2025-12-24",
        "status": "A",
        "authorized_official_last_name": "BORGMAN",
        "authorized_official_first_name": "KASEY",
        "authorized_official_middle_name": "D",
        "authorized_official_title_or_position": "DIRECTOR OF CORP COMPLIANCE",
        "authorized_official_telephone_number": "208-245-4576"
    },
    "taxonomies": [
        {
            "code": "3104A0625X",
            "taxonomy_group": "",
            "desc": "Assisted Living Facility, Assisted Living, Mental Illness",
            "state": "NU",
            "license": null,
            "primary": true
        },
        {
            "code": "3104A0630X",
            "taxonomy_group": "",
            "desc": "Assisted Living Facility, Assisted Living, Behavioral Disturbances",
            "state": "NU",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "805729800",
            "state": "ID"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Antelope Creek Assisted Living",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Antelope Creek Assisted Living",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Antelope Creek Assisted Living",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 24, 2025; 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.