HAWKS LANDING OF IDAHO LLC (NPI# 1235758897) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1235758897 |
| Entity Type | Organization |
| Organization Name | HAWKS LANDING OF IDAHO LLC |
| Practice Address |
222 Nighthawk Rd Bonners Ferry ID 83805-5441 |
| Practice Telephone | 2089467005 |
| Enumeration Date | 2020-04-14 |
| Last Update Date | 2020-04-14 |
| Authorized Official Name | MRS. SARA ELIZABETH TADLOCK (COO) |
| Authorized Official Telephone | 2082559460 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 322D00000X | Residential Treatment Facility, Emotionally Disturbed Children | Residential Treatment Facilities |
| Street Address |
222 NIGHTHAWK RD |
| City | BONNERS FERRY |
| State | ID |
| Zip Code | 83805-5441 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1528472321 | John Patrick Schrom | Counselor | 222 Nighthawk Rd, Bonners Ferry, ID 83805-5441 | 2014-06-19 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1366990996 | Nicole Diana Madill | Counselor | 687 Cody Street, Bonners Ferry, ID 83805 | 2016-09-12 |
| 1154770295 | Rachel Meiland Webster | Social Worker | 6686 Augusta Bldg 100, Bonners Ferry, ID 83805 | 2016-06-09 |
| 1205211786 | Robert Rossi | Social Worker | Kaniksu Health Services, 6615 Comanche St, Bonners Ferry, ID 83805 | 2015-07-24 |
| 1154660041 | Mark R. Barker, O.d.p.c. | Optometrist | 7177 Main St., Bonners Ferry, ID 83805 | 2013-02-12 |
| 1003182668 | Jessica Faye Horricks | Dentist | 6615 Commanche, Bonners Ferry, ID 83805 | 2012-03-28 |
| 1427334929 | Tanya Marie Allmaras | Physician Assistant | 6635 Comanche Street, Bonners Ferry, ID 83805 | 2011-10-27 |
| 1114259769 | Joshua Olen Shelton | Chiropractor | 6389 Bonner St., Bonners Ferry, ID 83805 | 2010-02-08 |
| 1558690644 | April C Christman | Social Worker | 6615 Comanche Street, Bonners Ferry, ID 83805 | 2009-12-18 |
| 1407006067 | Denys Taipale-knight | Counselor | 385 Moose Ridge Lane, Bonners Ferry, ID 83805 | 2008-09-19 |
| 1013126457 | John Pierce Brownlee Jr. | Registered Nurse | 6640 Kaniksu Street, Boundary Community Hospital, Bonners Ferry, ID 83805 | 2007-05-22 |
| Find all providers in zip 83805 | ||||
| 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 |
| 1619119864 | Ahs of Idaho | Residential Treatment Facility, Emotionally Disturbed Children | 911 Preacher Creek Rd, Shoshone, ID 83352-5061 | 2009-04-02 |
| City | BONNERS FERRY |
| Zip Code | 83805 |
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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.