STATE OF IDAHO (NPI# 1790131027) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1790131027 |
| Entity Type | Organization |
| Organization Name | STATE OF IDAHO |
| Practice Address |
1720 N Westgate Dr Boise ID 83704-7164 |
| Mailing Address |
2322 W State St Boise ID 83702-3161 |
| Practice Telephone | 2083340824 |
| Mailing Telephone | 2083340824 |
| Enumeration Date | 2016-05-05 |
| Last Update Date | 2016-05-05 |
| Authorized Official Name | MR. WAYNE NUBILE (CLINICAL SUPERVISOR) |
| Authorized Official Telephone | 2083340824 |
| Authorized Official Credential | LCPC |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 251S00000X | Community/Behavioral Health | LCPC-5579 | ID | Agencies |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1962755868 | State of Idaho | Intermediate Care Facility, Mentally Retarded | 1182 West Kyler Ave, Hayden, ID 83835 | 2012-10-17 |
| 1316063787 | State of Idaho | Intermediate Care Facility, Mentally Retarded | 1660 11th Ave N, Nampa, ID 83687-5000 | 2007-03-21 |
| 1750442315 | State of Idaho | Pharmacy | 700 East Alice Street, Blackfoot, ID 83221 | 2006-12-13 |
| 1801833454 | State of Idaho | Optometrist | 120 S Cole Rd, Suite 120 - Bldg 3, Boise, ID 83709-0932 | 2006-06-01 |
| 1649277393 | State of Idaho | Home Health | 1901 Alvin Ricken Dr, Pocatello, ID 83201-2727 | 2005-07-07 |
| 1053615260 | State of Idaho | Psychologist | 700 E Alice St, Blackfoot, ID 83221-4925 | 2011-01-03 |
| 1538285481 | State of Idaho | Optometrist | 1660 11th Ave N, Nampa, ID 83687-5000 | 2007-03-22 |
| 1588780449 | State of Idaho | Podiatrist | 1660 11th Ave N, Nampa, ID 83687-5000 | 2007-03-22 |
| 1265558019 | State of Idaho | Family Medicine | 1660 11th Ave N, Nampa, ID 83687-5000 | 2007-03-22 |
| 1235260829 | State of Idaho | Public Health or Welfare | 1901 Alvin Ricken Dr, Pocatello, ID 83201-2727 | 2007-03-08 |
| Street Address |
1720 N WESTGATE DR |
| City | BOISE |
| State | ID |
| Zip Code | 83704-7164 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1245561505 | Jaime Rochelle Marshall | Community Health Worker | 1720 N Westgate Dr, Boise, ID 83704-7164 | 2010-01-26 |
| 1568026698 | Sarah Rosenbloom | Social Worker | 1720 N Westgate Dr, Boise, ID 83704-7164 | 2019-04-24 |
| 1093297228 | Eric John Leitzinger II | Student in an Organized Health Care Education/Training Program | 1720 N Westgate Dr, Boise, ID 83704-7164 | 2018-09-04 |
| 1275015703 | Cade Kirkhart | Counselor | 1720 N Westgate Dr, Boise, ID 83704-7164 | 2018-08-31 |
| 1124508619 | Amy Palmer | Developmental Therapist | 1720 N Westgate Dr, Boise, ID 83704-7164 | 2018-08-15 |
| 1427543958 | Monisha Oconnor | Counselor | 1720 N Westgate Dr, Boise, ID 83704 | 2018-06-27 |
| 1154830081 | Tyler Quinn Kerns | Student in an Organized Health Care Education/Training Program | 1720 N Westgate Dr, Boise, ID 83704-7164 | 2017-09-22 |
| 1033635990 | Jessica Anderson | Registered Nurse | 1720 N Westgate Dr, Boise, ID 83704-7164 | 2017-08-22 |
| 1043742943 | Melissa Ann Howard | Social Worker | 1720 N Westgate Dr, Suite A1, Boise, ID 83704-7164 | 2017-03-30 |
| 1265973788 | John Griffin | Registered Nurse | 1720 N Westgate Dr, Suire A-1, Boise, ID 83704-7164 | 2017-03-16 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1215535893 | Laura Diggs | Counselor | 400 North Benjamin Lane, Suite 200, Boise, ID 83704 | 2020-10-15 |
| 1891304002 | Tree City Family Dental | Dentist | 7301 W. Emerald St Ste. 102, Boise, ID 83704 | 2020-07-24 |
| 1982230710 | Jessica Wynn Councell | Midwife | 1072 N Liberty St Ste 100, Boise, ID 83704 | 2020-03-12 |
| 1699307124 | Isabel Burns Bruce | Registered Nurse | 777 N Raymond Street, Boise, ID 83704 | 2020-02-12 |
| 1558903328 | Daring In Idaho, LLC | Social Worker | 413 N Allumbaugh Street, Suite 102, Boise, ID 83704 | 2019-10-14 |
| 1053960286 | Kyle Hiromi Hatanaka | Acupuncturist | 9450 #120 Fairview Avenue, Boise, ID 83704 | 2019-09-10 |
| 1700447141 | Katie Elizabeth Nichols | Physician Assistant | 1072 N Liberty St Ste 201, Boise, ID 83704 | 2019-06-26 |
| 1588164727 | Cory Michael Sims | Counselor | 6550 W. Emerald St #112, Boise, ID 83704 | 2018-02-14 |
| 1477072270 | Matthew Lee Love | Non-emergency Medical Transport (VAN) | 6933 W. Stratton St, Boise, ID 83704 | 2017-09-12 |
| 1942735949 | Dalana Sue Thompson | Counselor | 9196 Emerald St Suite #130, Boise, ID 83704 | 2017-04-27 |
| Find all providers in zip 83704 | ||||
| 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 |
|---|---|---|---|---|
| 1053938779 | Halo Health Services LLC | Community/Behavioral Health | 1111 S Orchard St, Boise, Id 83705, Boise, ID 83705 | 2020-06-29 |
| 1245854454 | Ken Wells Counseling | Community/Behavioral Health | 6654 E Bend Ridge St, Boise, ID 83716-5623 | 2020-06-03 |
| 1083236079 | Nakale Ball | Community/Behavioral Health | 3861 N Maple Grove Rd, Boise, ID 83704-4227 | 2020-05-12 |
| 1043859002 | Kacey E Mueller | Community/Behavioral Health | 688 N Avenue H Apt 304, Boise, ID 83712-6471 | 2019-12-22 |
| 1407499270 | Acceptance Counseling Services | Community/Behavioral Health | 5440 W Franklin Rd Ste 200, Boise, ID 83705-6434 | 2019-10-23 |
| 1154817021 | Hand In Hand | Community/Behavioral Health | 1830 W Airport Way, Boise, ID 83705-5101 | 2018-07-03 |
| 1982126264 | Brc Mental Health Services | Community/Behavioral Health | 963 S Orchard St Ste 103, Boise, ID 83705-1917 | 2017-07-08 |
| 1689109613 | Mrl Counseling LLC | Community/Behavioral Health | 9442 W Fairview Ave, Boise, ID 83704-8101 | 2017-04-27 |
| 1639601636 | Family Connection, Inc. | Community/Behavioral Health | 7154 W State St # 278, Boise, ID 83714-7421 | 2017-03-29 |
| 1164964045 | Jaimie Cain LLC | Community/Behavioral Health | 2210 N 31st St, Boise, ID 83703-5626 | 2016-11-09 |
| Find all providers in BOISE | ||||
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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.