1972724623 NPI number — COMMUNITY PARTNERSHIPS OF IDAHO, INC.

Table of content: (NPI 1972724623)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1972724623 NPI number — COMMUNITY PARTNERSHIPS OF IDAHO, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
COMMUNITY PARTNERSHIPS OF IDAHO, INC.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1972724623
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/09/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3098 N FIVE MILE RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BOISE
Provider Business Mailing Address State Name:
ID
Provider Business Mailing Address Postal Code:
83713-5215
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
208-376-4999
Provider Business Mailing Address Fax Number:
208-376-4988

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
9 WALL ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
NAMPA
Provider Business Practice Location Address State Name:
ID
Provider Business Practice Location Address Postal Code:
83651-3932
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
208-468-1077
Provider Business Practice Location Address Fax Number:
208-468-1071
Provider Enumeration Date:
05/01/2007

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
BRIGHT
Authorized Official First Name:
VICTORIA
Authorized Official Middle Name:
Authorized Official Title or Position:
MANAGER
Authorized Official Telephone Number:
208-405-0587

Provider Taxonomy Codes

  • Taxonomy code: 261QD1600X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 8052071 , issued by the state of ( ID ) . This identifiers is of the category "MEDICAID".