Provider Demographics
NPI:1194834010
Name:CHILDREN'S HOME SOCIETY OF IDAHO
Entity Type:Organization
Organization Name:CHILDREN'S HOME SOCIETY OF IDAHO
Other - Org Name:WARM SPRINGS COUNSELING CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:COO
Authorized Official - Prefix:MR
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:R
Authorized Official - Last Name:YOUNT
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:208-343-7797
Mailing Address - Street 1:740 WARM SPRINGS AVE
Mailing Address - Street 2:
Mailing Address - City:BOISE
Mailing Address - State:ID
Mailing Address - Zip Code:83712-6420
Mailing Address - Country:US
Mailing Address - Phone:208-343-7797
Mailing Address - Fax:208-343-0064
Practice Address - Street 1:740 WARM SPRINGS AVE
Practice Address - Street 2:
Practice Address - City:BOISE
Practice Address - State:ID
Practice Address - Zip Code:83712-6420
Practice Address - Country:US
Practice Address - Phone:208-343-7797
Practice Address - Fax:208-343-0064
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-30
Last Update Date:2009-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
No251S00000XAgenciesCommunity/Behavioral HealthGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ID00010006259OtherREGENCE BLUE SHIELD
ID88567OtherBLUE CROSS
ID002269500Medicaid