Organization
SUNBRIDGE HEALTHCARE LLC
Active
Other names
Boise Behavioral Health Hospital
Organization subpart
No
Provider details
NPI number
Authorized official
WILLIAM A. MATHIES (PRESIDENT DIRECTOR)
(505) 468-5013
Entity
Organization
Contact information
Practice address
8050 NORTHVIEW ST, BOISE, ID 83704-7126
(208) 327-0504
(208) 327-0594
Mailing address
101 SUN AVE NE, COMPLIANCE DEPARTMENT, ALBUQUERQUE, NM 87109-4373
(505) 468-5604
(505) 468-4681
Taxonomy
Speciality
Code
Description
License number
State
283Q00000X
Psychiatric Hospital
13D858805 (LAB)
ID
283Q00000X
Psychiatric Hospital
Primary
1650 HP (PHARM)
ID
283Q00000X
Psychiatric Hospital
55
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
2920900
—
ID
05
—
806765000
—
ID
05
—
806769400
—
ID
Enumeration date
05/31/2006
Last updated
01/22/2013
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