# AHS OF IDAHO

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- **Entity:** Organization
- **Status:** Active
- **Other names:** SUWS Adolescent & Youth Programs
- **Organization subpart:** No

## Provider details

- **NPI number:** 1619119864
- **Authorized official:** MS. KATHY REX CRT (EXECUTIVE DIRECTOR)
- **Authorized official phone:** (208) 886-2565

## Contact information

- **Practice address:** 911 PREACHER CREEK RD, SHOSHONE, ID 83352-5061
- **Practice address phone:** (208) 886-2565
- **Practice address fax:** (208) 886-2153
- **Mailing address:** 911 PREACHER CREEK RD, SHOSHONE, ID 83352-5061
- **Mailing address phone:** (208) 886-2565
- **Mailing address fax:** (208) 886-2153

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 322D00000X | Emotionally Disturbed Childrens' Residential Treatment Facility | 25860 | ID | Yes |

## Other

- **Enumeration date:** 04/02/2009
- **Last updated:** 04/02/2009