# HUMAN SUPPORTS OF IDAHO

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1700129491
- **Authorized official:** ALITA RUBY (ADMINISTRATIVE SERVICE MANAGER)
- **Authorized official phone:** (208) 454-8389

## Contact information

- **Practice address:** 206 E ELM ST, CALDWELL, ID 83605-4815
- **Practice address phone:** (208) 454-8389
- **Practice address fax:** (208) 454-8404
- **Mailing address:** 4477 W EMERALD ST STE C100, BOISE, ID 83706-2058
- **Mailing address phone:** (208) 321-0160
- **Mailing address fax:** (208) 321-0221

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 1041C0700X | Clinical Social Worker | — | NULL | — |
| 1041C0700X | Clinical Social Worker | — | — | — |
| 2084P0800X | Psychiatry Physician | — | NULL | — |
| 2084P0800X | Psychiatry Physician | — | — | — |
| 208D00000X | General Practice Physician | — | NULL | Yes |
| 208D00000X | General Practice Physician | — | — | Yes |
| 363A00000X | Physician Assistant | — | NULL | — |
| 363A00000X | Physician Assistant | — | — | — |
| 363LP0808X | Psychiatric/Mental Health Nurse Practitioner | — | NULL | — |
| 363LP0808X | Psychiatric/Mental Health Nurse Practitioner | — | — | — |

## Other

- **Enumeration date:** 04/01/2013
- **Last updated:** 12/23/2025

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 01 | — | 20002419 | MEDICARE PTAN | ID |