NPIMap

Organization Active NPI

Human Supports of Idaho, Inc.

  • Community/Behavioral Health Agency
  • Boise, ID
National Provider Identifier
1902949548
Registry record updated Dec 18, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
Community/Behavioral Health AgencyTaxonomy code 251S00000X
Legal business name
HUMAN SUPPORTS OF IDAHO, INC.
Practice address
4477 W Emerald St
Suite C-100
Boise, ID 83706-2000
Phone
(208) 321-0160
Fax
(208) 321-0221
NPI assigned
Feb 14, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 18, 2012

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

Authorized official

Name
Gregory L Dickerson, LMSW
Title
Administrator
Phone
(208) 321-0160

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Community/Behavioral Health Agency 251S00000X Primary

Addresses

Primary practice location

4477 W Emerald St
Suite C-100
Boise, ID 83706-2000

Mailing address

PO Box 820
Caldwell, ID 83606-0820
Phone (208) 454-8389

Other identifiers 1

IdentifierTypeStateIssuer
807345800MedicaidID

National Provider Directory

National Provider Directory
Tax ID family
Human Supports of Idaho Inc5 organizations share this tax ID, including this one

Other organizations with this tax ID 4

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

NPI Registry JSON

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

{
    "created_epoch": "1171411200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1355788800000",
    "number": "1902949548",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 820",
            "city": "CALDWELL",
            "state": "ID",
            "postal_code": "836060820",
            "telephone_number": "208-454-8389",
            "fax_number": "208-454-8404"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4477 W EMERALD ST",
            "address_2": "SUITE C-100",
            "city": "BOISE",
            "state": "ID",
            "postal_code": "837062000",
            "telephone_number": "208-321-0160",
            "fax_number": "208-321-0221"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "HUMAN SUPPORTS OF IDAHO, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-02-14",
        "last_updated": "2012-12-18",
        "status": "A",
        "authorized_official_last_name": "DICKERSON",
        "authorized_official_first_name": "GREGORY",
        "authorized_official_middle_name": "L",
        "authorized_official_title_or_position": "ADMINISTRATOR",
        "authorized_official_telephone_number": "208-321-0160",
        "authorized_official_credential": "LMSW"
    },
    "taxonomies": [
        {
            "code": "251S00000X",
            "taxonomy_group": "",
            "desc": "Community/Behavioral Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "807345800",
            "state": "ID"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Boise, ID

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 18, 2012; 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.