Organization
IDAHO YOUTH RANCH
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. KIMBERLY THOMAS CPA (CFO)
(208) 377-2613
Entity
Organization
Contact information
Practice address
5465 W IRVING ST, BOISE, ID 83706-1213
(208) 377-2613
Mailing address
5465 W IRVING ST, BOISE, ID 83706-1213
Taxonomy
Speciality
Code
Description
License number
State
261QM0855X
Adolescent and Children Mental Health Clinic/Center
Primary
—
—
322D00000X
Emotionally Disturbed Childrens' Residential Treatment Facility
—
—
323P00000X
Psychiatric Residential Treatment Facility
—
—
324500000X
Substance Abuse Rehabilitation Facility
—
ID
385HR2055X
Child Mental Illness Respite Care
—
—
Other
Enumeration date
10/01/2013
Last updated
04/06/2023
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