AHS OF IDAHO (NPI# 1619119864) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1619119864 |
| Entity Type | Organization |
| Organization Name | AHS OF IDAHO |
| Other Organization Name | SUWS ADOLESCENT & YOUTH PROGRAMS |
| Practice Address |
911 Preacher Creek Rd Shoshone ID 83352-5061 |
| Practice Telephone | 2088862565 |
| Practice Fax Number | 2088862153 |
| Mailing Telephone | 2088862565 |
| Mailing Fax Number | 2088862153 |
| Enumeration Date | 2009-04-02 |
| Last Update Date | 2009-04-02 |
| Authorized Official Name | MS. KATHY REX (EXECUTIVE DIRECTOR) |
| Authorized Official Telephone | 2088862565 |
| Authorized Official Credential | CRT |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 322D00000X | Residential Treatment Facility, Emotionally Disturbed Children | 25860 | ID | Residential Treatment Facilities |
| Other Name | Type Code |
|---|---|
| SUWS Adolescent & Youth Programs | Doing Business As Name - Organization |
| Street Address |
911 PREACHER CREEK RD |
| City | SHOSHONE |
| State | ID |
| Zip Code | 83352-5061 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1053860767 | Gooding Pharmacy Inc | Pharmacy | 120 South Apple, Suite A, Shoshone, ID 83352 | 2016-09-23 |
| 1851740716 | Matthew E. Kent, O.d.,p.a. | Optometrist | 520 N Greenwood St., Shoshone, ID 83352 | 2016-06-10 |
| 1689814980 | Lincoln Community Health | Community/Behavioral Health | 113 South Apple Street, Shoshone, ID 83352 | 2009-02-26 |
| 1154572311 | Southern Idaho Diabetes Education Program | Clinic/Center | 108 Nw Rail St, Shoshone, ID 83352 | 2008-10-07 |
| 1750309795 | Shoshone Rehab and Living Center | Skilled Nursing Facility | 511 East 4th Street, Shoshone, ID 83352 | 2006-07-18 |
| 1487648952 | Matthew E. Kent | Optometrist | 520 N Greenwood Street, Shoshone, ID 83352 | 2005-09-09 |
| 1497394506 | Krista Profit | Behavior Technician | 609 E 5th St, Shoshone, ID 83352-5191 | 2020-01-06 |
| 1043277635 | Keith E Davis | Family Medicine | 113 S Apple St, Shoshone, ID 83352-5287 | 2006-04-27 |
| 1619494614 | Barbara Hapayan | Nurse Practitioner | 113 S Apple St, Shoshone, ID 83352-5287 | 2017-08-29 |
| 1982055166 | Andrea Madson | Counselor | 113 S Apple St, Shoshone, ID 83352-5287 | 2016-06-28 |
| Find all providers in zip 83352 | ||||
| Taxonomy Code | 322D00000X |
| Grouping | Residential Treatment Facilities |
| Classification | Residential Treatment Facility, Emotionally Disturbed Children |
| A provider facility or distinct part of the organization which renders an interdisciplinary program of mental health treatment to individuals under 21 years of age who have persistent dysfunction in major life areas. The dysfunction is of an extent and pervasiveness that requires a protected and highly structured therapeutic environment. These organizations, or distinct part of organizations, exclude those that provide acute psychiatric care, partial hospitalization, group living, therapeutic schooling, primary diagnosis substance abuse disorder treatment, or primary diagnosis mental retardation or developmental disability treatment. |
| Notes: Source: U.S. Department of Defense Regulation 6010.8-R, Chapter 6. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1376935494 | Apex Adventure Therapy | Residential Treatment Facility, Emotionally Disturbed Children | 1832 E 1750 S, Gooding, ID 83330-5177 | 2015-02-26 |
| 1952738262 | Idaho Youth Ranch | Residential Treatment Facility, Emotionally Disturbed Children | 5465 W Irving St, Boise, ID 83706-1213 | 2013-10-01 |
| 1568758720 | Daybreak Canyon LLC | Residential Treatment Facility, Emotionally Disturbed Children | 1229 Country Club Rd., Kellogg, ID 83837 | 2011-06-24 |
| 1073843868 | Sequel Tsi of Idaho, LLC | Residential Treatment Facility, Emotionally Disturbed Children | 2850 Industrial Way, Mountain Home, ID 83647-3960 | 2009-12-30 |
| 1235758897 | Hawks Landing of Idaho LLC | Residential Treatment Facility, Emotionally Disturbed Children | 222 Nighthawk Rd, Bonners Ferry, ID 83805-5441 | 2020-04-14 |
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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.