NPIMap

Organization Active NPI

Brick House Recovery

  • Substance Use Disorder Rehabilitation Clinic/Center
  • Idaho Falls, ID
National Provider Identifier
1962050989
Registry record updated Dec 30, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Substance Use Disorder Rehabilitation Clinic/CenterTaxonomy code 261QR0405X
Legal business name
BRICK HOUSE RECOVERY
Practice address
1020 Land Bank St
Idaho Falls, ID 83402-1809
Phone
(801) 350-1716
NPI assigned
Sep 3, 2019
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 30, 2019

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

Authorized official

Name
Jason D Coombs, MPC
Title
Ceo
Phone
(801) 350-1716

Specialties & licenses 5

Specialty (taxonomy)CodeLicenseStatePrimary
CounselorGroup: 193200000X MULTI-SPECIALTY GROUP 101Y00000X
Addiction (Substance Use Disorder) CounselorGroup: 193200000X MULTI-SPECIALTY GROUP 101YA0400X
Mental Health CounselorGroup: 193200000X MULTI-SPECIALTY GROUP 101YM0800X
Community/Behavioral Health Agency 251S00000X
Substance Use Disorder Rehabilitation Clinic/Center 261QR0405X Primary

Addresses

Primary practice location

1020 Land Bank St
Idaho Falls, ID 83402-1809

Mailing address

3663 N Lakeharbor LN
Boise, ID 83703-6913
Phone (801) 350-1716

Other names 1

  • Brick House Recovery Former legal business name

National Provider Directory

National Provider Directory
Tax ID family
Brick House Recovery5 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.

Locations

1020 Land Bank St
Idaho Falls, ID 83402
Phone (208) 522-6155

Practitioners & affiliated clinicians

Practitioners 4

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1567468800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1577664000000",
    "number": "1962050989",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3663 N LAKEHARBOR LN",
            "city": "BOISE",
            "state": "ID",
            "postal_code": "837036913",
            "telephone_number": "801-350-1716"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1020 LAND BANK ST",
            "city": "IDAHO FALLS",
            "state": "ID",
            "postal_code": "834021809",
            "telephone_number": "801-350-1716"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BRICK HOUSE RECOVERY",
        "organizational_subpart": "NO",
        "enumeration_date": "2019-09-03",
        "last_updated": "2019-12-30",
        "certification_date": "2019-12-30",
        "status": "A",
        "authorized_official_last_name": "COOMBS",
        "authorized_official_first_name": "JASON",
        "authorized_official_middle_name": "D",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "801-350-1716",
        "authorized_official_credential": "MPC"
    },
    "taxonomies": [
        {
            "code": "101Y00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Counselor",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "101YA0400X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Counselor, Addiction (Substance Use Disorder)",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "101YM0800X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Counselor, Mental Health",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "251S00000X",
            "taxonomy_group": "",
            "desc": "Community/Behavioral Health",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261QR0405X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rehabilitation, Substance Use Disorder",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Brick House Recovery",
            "code": "4",
            "type": "Former Legal Business Name"
        }
    ]
}

Other providers in Idaho Falls, ID

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 30, 2019; 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.