STATE OF IDAHO (NPI# 1316063787) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1316063787 |
| Entity Type | Organization |
| Organization Name | STATE OF IDAHO |
| Other Organization Name | DHW IDAHO STATE SCHOOL AND HOPSITAL |
| Practice Address |
1660 11th Ave N Nampa ID 83687-5000 |
| Practice Telephone | 2084422812 |
| Practice Fax Number | 2084675978 |
| Mailing Telephone | 2084422812 |
| Mailing Fax Number | 2084675978 |
| Enumeration Date | 2007-03-21 |
| Last Update Date | 2020-08-22 |
| Authorized Official Name | SUE BROETJE (ADMINISTRATIVE DIRECTOR) |
| Authorized Official Telephone | 2084422812 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 315P00000X | Intermediate Care Facility, Mentally Retarded | 01 | ID | Nursing & Custodial Care Facilities |
| Other Name | Type Code |
|---|---|
| DHW IDAHO STATE SCHOOL AND HOPSITAL | Doing Business As Name - Organization |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1962755868 | State of Idaho | Intermediate Care Facility, Mentally Retarded | 1182 West Kyler Ave, Hayden, ID 83835 | 2012-10-17 |
| 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 |
| 1790131027 | State of Idaho | Community/Behavioral Health | 1720 N Westgate Dr, Boise, ID 83704-7164 | 2016-05-05 |
| 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 |
1660 11TH AVE N |
| City | NAMPA |
| State | ID |
| Zip Code | 83687-5000 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1265559314 | State of Idaho-dba Idaho State School & Hospital Pharmacy | Pharmacy | 1660 11th Ave N, Nampa, ID 83687-5000 | 2007-03-23 |
| 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 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1699307447 | Current Physical Therapy Nampa LLC | Physical Therapist | 16150 N High Desert Street, Nampa, ID 83687 | 2020-02-10 |
| 1356867683 | Nampa of Cascadia, LLC | Skilled Nursing Facility | 900 North Happy Valley Rd, Nampa, ID 83687 | 2017-08-18 |
| 1750828513 | Daniel & Max, LLC | Optometrist | 1600 Karcher Rd, Nampa, ID 83687 | 2017-01-31 |
| 1578965422 | Jorge Domingo Reyes | Counselor | 5700 E. Franklin Rd., Suite 220-i, Nampa, ID 83687 | 2014-09-23 |
| 1619302080 | David Lyle Farris | Dentist | 16548 North Franklin Blvd., Nampa, ID 83687 | 2013-09-04 |
| 1871934547 | Ian Zafar Qureshi | Internal Medicine | 4400 E Flamingo Ave Ste 130, Nampa, ID 83687 | 2013-07-10 |
| 1457696783 | Laurel Evans | Specialist/Technologist | 850 W. St. Luke's Dr., Suite 215, Nampa, ID 83687 | 2012-11-27 |
| 1750641197 | Andrea Patricia Fitzer | Nurse Practitioner | 4400 E. Flamingo Ave, Nampa, ID 83687 | 2012-05-18 |
| 1679846182 | Ivony Case Management | Case Management | 811 12th Street, Ste. 2, Nampa, ID 83687 | 2012-02-14 |
| 1699043679 | Saltzer Medical Group, P.a. | Durable Medical Equipment & Medical Supplies | 9850 W St Lukes Drive, Nampa, ID 83687 | 2011-12-06 |
| Find all providers in zip 83687 | ||||
| Taxonomy Code | 315P00000X |
| Grouping | Nursing & Custodial Care Facilities |
| Classification | Intermediate Care Facility, Mentally Retarded |
| (1) A public institution for care of the mentally retarded or people with related conditions. (2) An institution giving active treatment to mentally retarded or developmentally disabled persons or persons with related conditions. The primary purpose of the institution is to provide health or rehabilitative services to such individuals. |
| Notes: Sources: (1) Lexikon: Dictionary of Health Care Terms, Organizations and Acronyms for the Era of Reform, Joint Commission on Accreditation of Healthcare Organizations, Oakbrook Terrace, IL: 1994, p. 403 (2) Paraphrased from Code of Federal Regulations #42, Public Health, Section 440.150(c). |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1821125675 | Preferred Community Homes | Intermediate Care Facility, Mentally Retarded | 7591 Birch Ln, Nampa, ID 83687-8307 | 2007-02-28 |
| 1275660029 | Preferred Community Homes | Intermediate Care Facility, Mentally Retarded | 7904 Arlington Dr, Nampa, ID 83687-8338 | 2007-02-28 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1962755868 | State of Idaho | Intermediate Care Facility, Mentally Retarded | 1182 West Kyler Ave, Hayden, ID 83835 | 2012-10-17 |
| 1861742736 | Brenda Elaine Dilbeck | Intermediate Care Facility, Mentally Retarded | 4515 N Glenwood St, Boise, ID 83704-3012 | 2012-09-18 |
| 1902110380 | Belmont Management, Inc. | Intermediate Care Facility, Mentally Retarded | 6150 S. 5th Ave, Pocatello, ID 83204 | 2010-07-28 |
| 1760686687 | Idaho Falls Group Homes | Intermediate Care Facility, Mentally Retarded | 950 Periska Way, Idaho Falls, ID 83402-5141 | 2007-06-13 |
| 1235333576 | Idaho Falls Group Homes | Intermediate Care Facility, Mentally Retarded | 4360 Wanda St, Ammon, ID 83406-6878 | 2007-06-12 |
| 1447454798 | Idaho Falls Group Homes | Intermediate Care Facility, Mentally Retarded | 3612 Summit Run Trl, Idaho Falls, ID 83404-8247 | 2007-06-12 |
| 1730394644 | Independent Living Services, Inc. | Intermediate Care Facility, Mentally Retarded | 11577 Freedom Dr, Boise, ID 83713-3650 | 2007-05-14 |
| 1013122928 | Independent Living Services, Inc. | Intermediate Care Facility, Mentally Retarded | 10349 Summerwind Dr, Boise, ID 83704-3953 | 2007-05-14 |
| 1295948941 | Independent Living Services, Inc. | Intermediate Care Facility, Mentally Retarded | 10528 W Milclay St, Boise, ID 83704-3940 | 2007-05-08 |
| 1487867123 | Independent Living Services, Inc. | Intermediate Care Facility, Mentally Retarded | 1736 N Five Mile Rd, Boise, ID 83713-5408 | 2007-05-08 |
| Find all providers with the same taxonomy | ||||
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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.