1336901560 NPI number — SUPPORTIVE HOUSING AND INNOVATIVE PARTNERSHIPS

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1336901560 NPI number — SUPPORTIVE HOUSING AND INNOVATIVE PARTNERSHIPS

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SUPPORTIVE HOUSING AND INNOVATIVE PARTNERSHIPS
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:
1336901560
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/24/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 8803
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:
83707-2803
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
208-331-0900
Provider Business Mailing Address Fax Number:
208-331-0904

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
305 E 37TH ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
GARDEN CITY
Provider Business Practice Location Address State Name:
ID
Provider Business Practice Location Address Postal Code:
83714-6419
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
208-331-0900
Provider Business Practice Location Address Fax Number:
208-331-0904
Provider Enumeration Date:
01/24/2024

Additional Information

Authorized Official

Authorized Official Last Name:
WIDICK
Authorized Official First Name:
KENNETH
Authorized Official Middle Name:
DALE
Authorized Official Title or Position:
EXECUTIVE DIRECTOR
Authorized Official Telephone Number:
208-412-8338

Provider Taxonomy Codes

  • Taxonomy code: 251S00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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