Provider Demographics
NPI:1215391297
Name:PEER RECOVERY SUPPORTS OF IDAHO
Entity Type:Organization
Organization Name:PEER RECOVERY SUPPORTS OF IDAHO
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF OPERATIONS
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:ROBERT
Authorized Official - Last Name:BIGGINS
Authorized Official - Suffix:
Authorized Official - Credentials:MED, CADC
Authorized Official - Phone:208-352-0535
Mailing Address - Street 1:963 S ORCHARD ST
Mailing Address - Street 2:SUITE 202
Mailing Address - City:BOISE
Mailing Address - State:ID
Mailing Address - Zip Code:83705-1939
Mailing Address - Country:US
Mailing Address - Phone:208-352-0535
Mailing Address - Fax:
Practice Address - Street 1:963 S ORCHARD ST
Practice Address - Street 2:SUITE 202
Practice Address - City:BOISE
Practice Address - State:ID
Practice Address - Zip Code:83705-1939
Practice Address - Country:US
Practice Address - Phone:208-352-0535
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-04-06
Last Update Date:2016-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ID251B00000X
251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management
No251S00000XAgenciesCommunity/Behavioral Health