IDAHO DEPT OF HEALTH & WELFARE REG 1 CMH PSR CDA (NPI# 1164550455) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1164550455 |
| Entity Type | Organization |
| Organization Name | IDAHO DEPT OF HEALTH & WELFARE REG 1 CMH PSR CDA |
| Practice Address |
1250 Ironwood Dr Ste 100 Coeur D Alene ID 83814-2628 |
| Practice Telephone | 2087691515 |
| Practice Fax Number | 2086666744 |
| Mailing Telephone | 2087691515 |
| Mailing Fax Number | 2086666744 |
| Enumeration Date | 2007-03-01 |
| Last Update Date | 2020-08-22 |
| Authorized Official Name | CORA JO GUSSENHOVEN (PROGRAM MANAGER) |
| Authorized Official Telephone | 2087691406 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 261QR0400X |
Clinic/Center Specialization: Rehabilitation |
Ambulatory Health Care Facilities |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| BLUE CROSS OF IDAHO | HW199 | 01 | |
| ID | 0028408 | 05 | |
| BLUE SHIELD | 000010018348 | 01 |
| Street Address |
1250 IRONWOOD DR STE 100 |
| City | COEUR D ALENE |
| State | ID |
| Zip Code | 83814-2628 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1477162675 | Dehra Mcfaddan | Social Worker | 211 E. Coeur D'alene Ave, 102, Coeur D Alene, ID 83814 | 2020-07-24 |
| 1043838634 | Yendi Labelle | Nurse Practitioner | 1115 N Ironwood Drive, Coeur D'alene, ID 83814 | 2020-07-09 |
| 1295353217 | Cultivation, LLC | Counselor | 211 E. Coeur Dalene Ave. Ste 102, Coeur D'alene, ID 83814 | 2020-07-07 |
| 1306487517 | Northwest Integrated Health, LLP | Clinic/Center | 1250 West N. Northwood Center Ct, Suite B, Coeur D'alene, ID 83814 | 2019-09-30 |
| 1730740465 | Connor Williams | Physical Therapist | 1812 W Lakewood Dr, Ste. 100, Coeur D Alene, ID 83814 | 2019-06-24 |
| 1912480153 | Nadine M Lewis | Social Worker | 211 E. Coeur D'alene Ave., Coeur D'alene, ID 83814 | 2018-09-13 |
| 1992208631 | Orthopedic Surgery and Sports | Orthopaedic Surgery | 1812 N Lakewood Drive, Suite 100, Coeur D'alene, ID 83814 | 2018-03-08 |
| 1346758042 | Heather Marie Johnson | Counselor | 7905 Meadowlark Way, Cda, ID 83814 | 2018-01-16 |
| 1881113413 | Brevity Treatment Services | Counselor | 2201 N. Government Way Ste. L, Coeur D'alene, ID 83814 | 2017-09-14 |
| 1366969628 | Jennifer La Gina Highfield | Massage Therapist | 1104 N Ste B, Coeur D Alene, ID 83814 | 2017-08-28 |
| Find all providers in zip 83814 | ||||
| Taxonomy Code | 261QR0400X |
| Grouping | Ambulatory Health Care Facilities |
| Classification | Clinic/Center |
| Specialization | Rehabilitation |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1043657828 | Bodybalance Pt Twin Falls LLC | Clinic/Center | 657 Blue Lakes Blvd N, Twin Falls, ID 83301-4036 | 2013-06-03 |
| 1669503066 | Idaho Dept of Health & Welfare R5 Cmh Psr Jer | Clinic/Center | 126 N Adams St, Jerome, ID 83338-2331 | 2007-03-08 |
| 1396876850 | Idaho Dept. of Health & Welfare | Clinic/Center | 803 Harrison St., Twin Falls, ID 83301-3925 | 2007-03-08 |
| 1720116551 | Idaho Dept of Health & Welfare Reg II Cmh Moscow | Clinic/Center | 1350 Troy Hwy, Moscow, ID 83543-3995 | 2007-03-01 |
| 1023487105 | Journey Pediatric Therapy | Clinic/Center | 506 Alder St Fl 2, Sandpoint, ID 83864-1567 | 2015-09-18 |
| 1851787980 | Fit Technologies Pllc | Clinic/Center | 3544 E 17th St, Suite 201, Ammon, ID 83406-6911 | 2015-04-15 |
| 1053729434 | Celebration Speech Inc | Clinic/Center | 3715 Woodking Dr, Idaho Falls, ID 83404-4720 | 2014-07-29 |
| 1689082182 | Generations Occupational Therapy | Clinic/Center | 3715 Woodking Dr, Idaho Falls, ID 83404-4720 | 2014-07-28 |
| 1942616073 | St Luke's Elks Childrens Rehabilitation | Clinic/Center | 3525 E Louise Dr, Suite 255, Meridian, ID 83642-6302 | 2014-07-09 |
| 1750620159 | Saint Alphonsus Regional Medical Center Inc | Clinic/Center | 4400 E Flamingo Ave, Nampa, ID 83687 | 2013-02-05 |
| Find all providers with the same taxonomy | ||||
| City | COEUR D ALENE |
| Zip Code | 83814 |
Please comment or provide details below to improve the information on IDAHO DEPT OF HEALTH & WELFARE REG 1 CMH PSR CDA.
| 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.