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Organization
HUMAN SUPPORTS OF IDAHO
Active
Organization
HUMAN SUPPORTS OF IDAHO
Active
Organization subpart
No
Provider details
NPI number
Authorized official
ALITA RUBY (ADMINISTRATIVE SERVICE MANAGER)
(208) 454-8389
Entity
Organization
Contact information
Practice address
206 E ELM ST, CALDWELL, ID 83605-4815
(208) 454-8389
(208) 454-8404
Mailing address
4477 W EMERALD ST STE C100, BOISE, ID 83706-2058
(208) 321-0160
(208) 321-0221
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
—
NULL
1041C0700X
Clinical Social Worker
—
—
2084P0800X
Psychiatry Physician
—
NULL
2084P0800X
Psychiatry Physician
—
—
208D00000X
General Practice Physician
Primary
—
NULL
208D00000X
General Practice Physician
Primary
—
—
363A00000X
Physician Assistant
—
NULL
363A00000X
Physician Assistant
—
—
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
—
NULL
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
20002419
MEDICARE PTAN
ID
Enumeration date
04/01/2013
Last updated
12/23/2025
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