STATE OF IDAHO (NPI# 1962755868) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1962755868 |
| Entity Type | Organization |
| Organization Name | STATE OF IDAHO |
| Other Organization Name | SWITC-KYLER HOUSE |
| Practice Address |
1182 West Kyler Ave Hayden ID 83835 |
| Mailing Address |
1660 11th Ave N Nampa ID 83687-5000 |
| Practice Telephone | 2087620244 |
| Practice Fax Number | 2087620269 |
| Mailing Telephone | 2084422812 |
| Mailing Fax Number | 2084675978 |
| Enumeration Date | 2012-10-17 |
| Last Update Date | 2012-10-17 |
| Authorized Official Name | SUSAN BROETJE (ADMINISTRATOR) |
| Authorized Official Telephone | 2086970625 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 315P00000X | Intermediate Care Facility, Mentally Retarded | 81 | ID | Nursing & Custodial Care Facilities |
| Other Name | Type Code |
|---|---|
| SWITC-Kyler House | Doing Business As Name - Organization |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1316063787 | State of Idaho | Intermediate Care Facility, Mentally Retarded | 1660 11th Ave N, Nampa, ID 83687-5000 | 2007-03-21 |
| 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 |
1182 WEST KYLER AVE |
| City | HAYDEN |
| State | ID |
| Zip Code | 83835 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1881212371 | Ngan T Nguyen | Pharmacist | 161 E. Prairie Shopping Center, Hayden, ID 83835 | 2020-07-10 |
| 1689158461 | Rskiom, Pllc | Electrodiagnostic Medicine | 9323 N Government Way #6, Hayden, ID 83835 | 2018-09-18 |
| 1235616913 | Kimberly Jill Young | Dietitian, Registered | 8500 N. Atlas Rd., Hayden, ID 83835 | 2018-07-25 |
| 1851894380 | Medicine Man North Pharmacy Inc | Pharmacy | 30585 N Roberts Rd, Hayden, ID 83835 | 2018-03-11 |
| 1366997322 | Jennifer Amber Belmont | Social Worker | 8680 N Wayne Dr, Suite A, Hayden, ID 83835 | 2016-08-19 |
| 1548637994 | Dance Dentistry Pllc | Clinic/Center | 1027 W Prairie Ave, Hayden, ID 83835 | 2015-09-01 |
| 1982012498 | Dallin J. Dance | Dentist | 1027 W. Prairie Ave., Hayden, ID 83835 | 2014-07-28 |
| 1669808614 | Integrated Interventions LLC | Clinic/Center | 2482 E. Glacier Rd., Hayden Lake, ID 83835 | 2013-09-23 |
| 1669812301 | Caleb Jerome Foss | Physical Therapist | 8382 N Wayne Dr Ste 100, Hayden, ID 83835 | 2013-06-26 |
| 1437493798 | Joseph Neal Tessendorf | Chiropractor | 1401 Biztown Loop, Hayden, ID 83835 | 2012-11-26 |
| Find all providers in zip 83835 | ||||
| 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 |
|---|---|---|---|---|
| 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 |
| 1689896805 | Tomorrow's Hope Inc | Intermediate Care Facility, Mentally Retarded | 1655 Fairview Ave, Suite 100, Boise, ID 83702-0000 | 2007-05-03 |
| 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.