NPIMap

Organization Active NPI

State of Idaho

  • Intellectual Disabilities Intermediate Care Facility
  • Hayden, ID
National Provider Identifier
1962755868
Registry record updated Oct 17, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
Intellectual Disabilities Intermediate Care FacilityTaxonomy code 315P00000X
License
81 Issued in ID
Legal business name
STATE OF IDAHO
Practice address
1182 West Kyler Ave
Hayden, ID 83835
Phone
(208) 762-0244
Fax
(208) 762-0269
NPI assigned
Oct 17, 2012
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 17, 2012

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

Authorized official

Name
Susan Broetje
Title
Administrator
Phone
(208) 697-0625

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Intellectual Disabilities Intermediate Care Facility 315P00000X 81 ID Primary

Addresses

Primary practice location

1182 West Kyler Ave
Hayden, ID 83835

Mailing address

1660 11TH Ave N
Nampa, ID 83687-5000
Phone (208) 442-2812

Other names 1

  • SWITC-Kyler House Doing business as

National Provider Directory

National Provider Directory
Tax ID family
Reg VI Mental Health Ctr114 organizations share this tax ID, including this one

Organizations with this tax ID in the same state 14

This tax ID family is large, so up to 24 of its organizations in the same state are linked here.

View all 14

NPI Registry JSON

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

{
    "created_epoch": "1350432000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1350432000000",
    "number": "1962755868",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1660 11TH AVE N",
            "city": "NAMPA",
            "state": "ID",
            "postal_code": "836875000",
            "telephone_number": "208-442-2812",
            "fax_number": "208-467-5978"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1182 WEST KYLER AVE",
            "city": "HAYDEN",
            "state": "ID",
            "postal_code": "83835",
            "telephone_number": "208-762-0244",
            "fax_number": "208-762-0269"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "STATE OF IDAHO",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-10-17",
        "last_updated": "2012-10-17",
        "status": "A",
        "authorized_official_last_name": "BROETJE",
        "authorized_official_first_name": "SUSAN",
        "authorized_official_title_or_position": "ADMINISTRATOR",
        "authorized_official_telephone_number": "208-697-0625"
    },
    "taxonomies": [
        {
            "code": "315P00000X",
            "taxonomy_group": "",
            "desc": "Intermediate Care Facility, Intellectual Disabilities",
            "state": "ID",
            "license": "81",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "SWITC-Kyler House",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Hayden, ID

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 17, 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.