IDAHODHWBH3 CALDWELL CMH PSR NPI 1063540359

Clinic/Center (Rehabilitation) in Caldwell, ID

About IDAHODHWBH3 CALDWELL CMH PSR

Idahodhwbh3 Caldwell Cmh Psr is a provider in Caldwell, ID. The NPI number assigned to this provider is 1063540359. The practitioner's primary taxonomy code is Clinic/Center (261QR0400X). The provider is registered as an organization and their NPI record was last updated 11 years ago.

NPI

1063540359

Additional informationCallout TooltipNational Provider Indentifier (NPI)
The 10-position all-numeric identification number assigned by the NPPES to uniquely identify a health care provider.
Provider NameIDAHODHWBH3 CALDWELL CMH PSR
Provider Location Address3402 FRANKLIN RD CALDWELL, ID 83605 Additional informationCallout TooltipProvider location address
The location address of the provider being identified. For providers with more than one physical location, this is the primary location. This address cannot include a Post Office box.
Provider Mailing Address3402 FRANKLIN RD CALDWELL, ID 83605 Additional informationCallout TooltipProvider mailing address
The mailing address of the provider being identified. This address may contain the same information as the provider location address.
NPI Entity TypeOrganization Additional informationCallout TooltipEntity type code
The code describing the type of health care provider that is being assigned an NPI.
Codes are:
1 = (Person): individual human being who furnishes health care;
2 = (Non-person): entity other than an individual human being that furnishes health care (Examples: hospital, SNF, hospital subunit, pharmacy, or HMO).
Is Sole Proprietor?N/A
Is Organization Subpart?N/A Additional informationCallout TooltipWhat is a subpart?
Subparts are the components and separate physical locations of organization health care providers. Examples include:
Hospital components include outpatient departments, surgical centers, psychiatric units, and laboratories. These components are often separately licensed or certified by States and may exist at physical locations other than that of the hospital of which they are a component.
Enumeration Date03-01-2007 Additional informationCallout TooltipProvider enumeration date
The date the provider was assigned a unique identifier (assigned an NPI)
Last Update Date07-08-2007 Additional informationCallout TooltipLast update date
The date that a record was last updated or changed.

Primary Taxonomy

Taxonomy Code261QR0400X Additional informationCallout TooltipPrimary Taxonomy Code
The primary taxonomy code defines the provider type, classification, and specialization. There could be only one primary taxonomy code per NPI record. For individual NPIs the license data is associated to the taxonomy code.
ClassificationClinic/Center
TypeAmbulatory Health Care Facilities
SpecializationRehabilitation

Business Address

IDAHODHWBH3 CALDWELL CMH PSR
3402 FRANKLIN RD
CALDWELL, ID
ZIP 83605
Phone: (208) 459-0092
Fax: (208) 454-7714

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Mailing Address

IDAHODHWBH3 CALDWELL CMH PSR
3402 FRANKLIN RD
CALDWELL, ID
ZIP 83605
Phone: (208) 459-0092
Fax: (208) 454-7714

Authorized Official

Authorized Official NameMR. TODD L HURT M.S. Additional informationCallout TooltipAuthorized official name
The name of the person authorized to submit the NPI application or to officially change data for a health care provider.
Authorized Official TitleFIELD OPERATIONS MANAGER
Authorized Official Phone(208) 455-7057

Additional Identifiers


Additional identifier(s) currently or formerly used as an identifier for the provider. The codes may include UPIN, NSC, OSCAR, DEA, Medicaid State or PIN identification numbers.

Identifier Type / Code Identifier State
0028416MEDICAID (05)ID
000010018824OTHER (01)
HW348OTHER (01)

Other Providers at the same location


The following 20 providers are registered at the same or nearby location.

NPI Name / Type Taxonomy Address
1023146529IDAHODHWBH3 CALD AMH PSR
Organization
Clinic/Center (Mental Health (Including Community Mental Health Center))3402 FRANKLIN RD
CALDWELL, ID 83605
(208) 459-0092
1023464310 GLORIA TAGUE LSW
Individual
Social Worker3402 FRANKLIN RD
CALDWELL, ID 83605
(208) 459-0092
1023471851MRS. AMANDA KAY GOLDSTON LCSW
Individual
Social Worker (Clinical)3402 FRANKLIN RD
CALDWELL, ID 83605
(208) 455-7045
1063875383 LAURA ALVAREZ
Individual
Counselor (Mental Health)3402 FRANKLIN RD
CALDWELL, ID 83605
(208) 455-7085
1104004928IDAHO DEPT OF HEALTH & WELFARE AMHCALPGREG3
Organization
Psychologist (Prescribing (Medical))3402 FRANKLIN RD
CALDWELL, ID 83605
(208) 459-0092
1104289305MS. ASHA SHARP LMSW
Individual
Social Worker (Clinical)3402 FRANKLIN RD
CALDWELL, ID 83605
(208) 455-7033
1144530718IDAHO DEPARTMENT OF HEALTH & WELFARE
Organization
Clinic/Center (Adolescent and Children Mental Health)3402 FRANKLIN RD
CALDWELL, ID 83605
(208) 459-0092
1235592973 BROOK HEATH LCSW
Individual
Social Worker (Clinical)3402 FRANKLIN RD
CALDWELL, ID 83605
(208) 455-7074
1295979318 RANDON KESSINGER
Individual
Social Worker (Clinical)3402 FRANKLIN RD
CALDWELL, ID 83605
(208) 455-7065
1427186717IDAHODHWBH3 CASE MANAGEMENT
Organization
Case Management3402 FRANKLIN RD
CALDWELL, ID 83605
(208) 459-0092
1457707770 LISA COMSTOCK MSW
Individual
Social Worker (Clinical)3402 FRANKLIN RD
CALDWELL, ID 83605
(208) 455-7031
1467720268 LINDSEY BARROSO R.N.
Individual
Clinical Nurse Specialist (Psych/Mental Health)3402 FRANKLIN RD
CALDWELL, ID 83605
(208) 459-0092
1679841480 CYNTHIA USOG R.N.
Individual
Clinical Nurse Specialist (Psych/Mental Health)3402 FRANKLIN RD
CALDWELL, ID 83605
(208) 459-0092
1700249000MS. GENA DUNHAM LSCW
Individual
Social Worker (Clinical)3402 FRANKLIN RD
CALDWELL, ID 83605
(208) 455-7046
1700913340IDAHO DHWBH3 CALDAMHCLINIC
Organization
Clinic/Center (Adult Mental Health)3402 FRANKLIN RD
CALDWELL, ID 83605
(208) 459-0092
1881722171IDAHODHWBH3 NP
Organization
Nurse Practitioner3402 FRANKLIN RD
CALDWELL, ID 83605
(208) 459-0092
1891141107 JESSICA WERST LMSW
Individual
Social Worker3402 FRANKLIN RD
CALDWELL, ID 83605
(208) 455-7063
1952757288MR. BRIAN LINDNER LCPC
Individual
Counselor (Professional)3402 FRANKLIN RD
CALDWELL, ID 83605
(208) 455-7092
1962770776 TERI MOHR R.N.
Individual
Clinical Nurse Specialist (Psych/Mental Health)3402 FRANKLIN RD
CALDWELL, ID 83605
(208) 459-0092
1972631265IDAHODHWBH3 MIDLEVEL GROUP
Organization
Nurse Practitioner3402 FRANKLIN RD
CALDWELL, ID 83605
(208) 459-0092
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