SOUTH FORK SERVICES, LLC (NPI# 1588006217) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1588006217 |
| Entity Type | Organization |
| Organization Name | SOUTH FORK SERVICES, LLC |
| Practice Address |
310 N 2nd E Ste 128 Rexburg ID 83440-1607 |
| Practice Telephone | 2083565675 |
| Mailing Telephone | 2083565675 |
| Enumeration Date | 2013-07-23 |
| Last Update Date | 2013-07-23 |
| Authorized Official Name | WADE GORDON (OWNER) |
| Authorized Official Telephone | 2083565675 |
| Authorized Official Credential | LCSW |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 251S00000X | Community/Behavioral Health | LCSW 27205 | ID | Agencies |
| Street Address |
310 N 2ND E STE 128 |
| City | REXBURG |
| State | ID |
| Zip Code | 83440-1607 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1770915076 | Sarah E. Dickey | Social Worker | 310 N 2nd E Ste 128, Rexburg, ID 83440-1607 | 2013-08-08 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1235768490 | Henry's Fork Surgery Center Pllc | Clinic/Center | 23 Sawtelle Ave, Rexburg, ID 83440 | 2020-04-08 |
| 1952956906 | Shane Ellis Withers | Pharmacist | 164 E. Main, Rexburg, ID 83440 | 2019-08-06 |
| 1316392285 | Emma Anderson | Speech-Language Pathologist | 36 Professional Plaza Suite 110, Rexburg, ID 83440 | 2016-04-28 |
| 1851755524 | Sandra Frickey | Speech-Language Pathologist | 1087 Summers Drive, Premier Therapy Associates, Rexburg, ID 83440 | 2016-04-08 |
| 1275997215 | Kerry Denney | Counselor | 333 Walker Drive, Rexburg, ID 83440 | 2016-04-06 |
| 1467837583 | Wal-mart Stores, Inc. | Technician/Technologist | 303 E Moody Rd, Rexburg, ID 83440 | 2015-07-30 |
| 1649692609 | Tanabell Health Services, Inc. | Skilled Nursing Facility | 410 W 1st N, Rexburg, ID 83440 | 2014-01-10 |
| 1043652571 | Creed Simon Webster | Counselor | 30 S 2nd W, Rexburg, ID 83440 | 2013-07-25 |
| 1033461660 | James Cannon Allen Dds PC | Dentist | 106 E 1st North, Rexburg, ID 83440 | 2012-10-05 |
| 1417217316 | Shelby Dee Woolstenhulme | Speech-Language Pathologist | 450 E. Main Street, Rexburg, ID 83440 | 2012-05-24 |
| Find all providers in zip 83440 | ||||
| Taxonomy Code | 251S00000X |
| Grouping | Agencies |
| Classification | Community/Behavioral Health |
| A private or public agency usually under local government jurisdiction, responsible for assuring the delivery of community based mental health, mental retardation, substance abuse and/or behavioral health services to individuals with those disabilities. Services may range from companion care, respite, transportation, community integration, crisis intervention and stabilization, supported employment, day support, prevocational services, residential support, therapeutic and supportive consultation, environmental modifications, intensive in-home therapy and day treatment, in addition to traditional mental health and behavioral treatment. |
| Notes: Source: National Medicaid EDI HIPAA NPI Sub Work Group [1/1/2007: modified definition] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1427445782 | Intouch Recovery | Community/Behavioral Health | 1037 Erikson Dr, Rexburg, ID 83440-5297 | 2015-04-23 |
| 1316188964 | Your Supportive Services, LLC | Community/Behavioral Health | 343 E 4th N Ste 121, Rexburg, ID 83440-6004 | 2009-03-11 |
| 1639329535 | Family Center Inc | Community/Behavioral Health | 534 Trejo St Ste 300, Rexburg, ID 83440-5405 | 2008-09-26 |
| 1134458102 | Centerpoint Counseling Services, LLC | Community/Behavioral Health | 393 E 2nd N, Rexburg, ID 83440-1605 | 2009-12-21 |
| 1427290881 | Expressions Supportive Services, LLC | Community/Behavioral Health | 343 East 4th North, Suite 121, Rexburg, ID 83440 | 2009-04-01 |
| 1255582334 | June Ellen Cox | Community/Behavioral Health | 343 E 4th N, Rexburg, ID 83440-1684 | 2008-10-07 |
| 1871700534 | Lds Family Services | Community/Behavioral Health | 631 N 200 E, Rexburg, ID 83440-3599 | 2007-05-16 |
| 1629294509 | Ostermiller Counseling Services Inc. | Community/Behavioral Health | 218 Dividend Dr, Ste 3, Rexburg, ID 83440-3510 | 2007-04-18 |
| 1861544587 | Upper Valley Resource and Counseling Center | Community/Behavioral Health | 36 N 2nd W, Rexburg, ID 83440-1515 | 2007-01-16 |
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|---|---|---|---|---|
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| 1811502313 | Mindful Moments LLC | Community/Behavioral Health | 15636 N Highway 41 Ste 700, Rathdrum, ID 83858-8710 | 2020-09-10 |
| 1467064139 | Treasure Valley Compassionate Therapy, LLC | Community/Behavioral Health | 101 11th Ave S Ste 225, Nampa, ID 83651-3918 | 2020-08-23 |
| 1538779566 | Carolyn Elizabeth Barndt | Community/Behavioral Health | 1302 12th St, Lewiston, ID 83501-2932 | 2020-08-04 |
| 1053938779 | Halo Health Services LLC | Community/Behavioral Health | 1111 S Orchard St, Boise, Id 83705, Boise, ID 83705 | 2020-06-29 |
| 1023634672 | Padron Counseling Services, LLC | Community/Behavioral Health | 522 Lomax St, Idaho Falls, ID 83401-2634 | 2020-06-19 |
| 1245854454 | Ken Wells Counseling | Community/Behavioral Health | 6654 E Bend Ridge St, Boise, ID 83716-5623 | 2020-06-03 |
| 1982227534 | Bonnie Bray | Community/Behavioral Health | 99 East Fork Road, Hailey, ID 83333 | 2020-05-18 |
| 1083236079 | Nakale Ball | Community/Behavioral Health | 3861 N Maple Grove Rd, Boise, ID 83704-4227 | 2020-05-12 |
| 1487283917 | Emma Orthel Therapy, Pllc | Community/Behavioral Health | 210 N 3rd E, Mountain Home, ID 83647-2733 | 2020-04-06 |
| Find all providers with the same taxonomy | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.