Idaho Dept of Health & Welfare Region 4 CMH PSR Boise
Organization Active NPI Rehabilitation Clinic/Center · Boise, ID
NPI 1891825824 · NPPES record last updated Aug 22, 2020
Key facts
- NPI
- 1891825824
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Rehabilitation Clinic/Center 261QR0400X
- Legal business name
- IDAHO DEPT OF HEALTH & WELFARE REGION 4 CMH PSR BOISE
- Practice address
- 1720 Westgate Dr
Suite D
Boise, ID 83704-7164 - Phone
- (208) 334-0792
- Fax
- (208) 334-0812
- NPI assigned
- Mar 7, 2007
- Organization subpart
- No
Authorized official
- Name
- Gina Westcott, M.A.
- Title
- Program Manager
- Phone
- (208) 334-0969
Corporate family (same tax ID) 17
Practitioners 8
National Provider Directory
- Tax ID family
- Reg VI Mental Health Ctr
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Rehabilitation Clinic/Center | 261QR0400X | Yes |
Addresses
Primary practice location
1720 Westgate Dr
Suite D
Boise, ID 83704-7164
Mailing address
1720 Westgate Dr
Suite D
Boise, ID 83704-7164
Phone (208) 334-0792
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 000010019129 | Other | BLUE SHIELD | |
| HW090 | Other | BLUE CROSS OF IDAHO | |
| 0028402 | Medicaid | ID |
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- Idaho Dept of Health & Welfare Amh Clinic Boise
- Idaho Dept of Health & Welfare Amh PSR Boise
- Idaho Dept of Health & Welfare CMH Clinic Boise
- Idaho Dept of Health & Welfare Esc Region 4
- Idaho Dept of Health & Welfare Itp Region 4
- Idaho Dermatologic Surgery & Laser Center PA
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- Idaho Diabetes and Endocrine Associates, PA
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All providers in Boise, ID · Rehabilitation 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.