Organization
IDAHO DEPT OF HEALTH & WELFARE AMH CLINIC BOISE
Active
Organization subpart
No
Provider details
NPI number
Authorized official
GINA WESTCOTT M.A. (PROGRAM MANAGER)
(208) 334-0969
Entity
Organization
Contact information
Practice address
1720 WESTGATE DR, SUITE B-1, BOISE, ID 83704-7164
(208) 334-0894
(208) 334-0804
Mailing address
1720 WESTGATE DR, SUITE B-1, BOISE, ID 83704-7164
(208) 334-0894
(208) 334-0804
Taxonomy
Speciality
Code
Description
License number
State
261QM0850X
Adult Mental Health Clinic/Center
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000010018973
BLUE SHIELD
—
05
—
0028320
—
ID
01
—
HW280
BLUE CROSS OF IDAHO
—
Enumeration date
03/07/2007
Last updated
08/22/2020
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