Provider Demographics
NPI: | 1235501503 |
---|---|
Name: | HISWAY, LLC |
Entity Type: | Organization |
Organization Name: | HISWAY, LLC |
Other - Org Name: | HISWAY, LLC DBA ALPINE BEHAVIORAL HEALTH |
Other - Org Type: | Doing Business As |
Authorized Official - Title/Position: | OWNER/ADMINISTRATOR |
Authorized Official - Prefix: | MS |
Authorized Official - First Name: | ELLEN |
Authorized Official - Middle Name: | M |
Authorized Official - Last Name: | HAMPTON |
Authorized Official - Suffix: | |
Authorized Official - Credentials: | |
Authorized Official - Phone: | 208-860-7124 |
Mailing Address - Street 1: | 8590 W FAIRVIEW AVE |
Mailing Address - Street 2: | |
Mailing Address - City: | BOISE |
Mailing Address - State: | ID |
Mailing Address - Zip Code: | 83704-8320 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 208-322-0262 |
Mailing Address - Fax: | 208-672-0238 |
Practice Address - Street 1: | 8590 W FAIRVIEW AVE |
Practice Address - Street 2: | |
Practice Address - City: | BOISE |
Practice Address - State: | ID |
Practice Address - Zip Code: | 83704-8320 |
Practice Address - Country: | US |
Practice Address - Phone: | 208-322-0262 |
Practice Address - Fax: | 208-672-0238 |
EIN: | <UNAVAIL> |
Is Organization Subpart?: | No |
Parent Organization LBN: | |
Parent Organization TIN: | |
Enumeration Date: | 2015-10-27 |
Last Update Date: | 2015-10-27 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Licenses
State | License ID | Taxonomies |
---|---|---|
ID | M8075856 | 253Z00000X |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization |
---|---|---|---|---|
Yes | 253Z00000X | Agencies | In Home Supportive Care |