Provider Demographics
NPI:1326129909
Name:SUNHEALTH BEHAVIORAL SYSTEMS FOR BOISE
Entity Type:Organization
Organization Name:SUNHEALTH BEHAVIORAL SYSTEMS FOR BOISE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:COUNSELOR
Authorized Official - Prefix:MISS
Authorized Official - First Name:DEANNA
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:JOHANNSEN
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:208-327-0504
Mailing Address - Street 1:8050 NORTHVIEW ST
Mailing Address - Street 2:
Mailing Address - City:BOISE
Mailing Address - State:ID
Mailing Address - Zip Code:83704-7126
Mailing Address - Country:US
Mailing Address - Phone:208-327-0504
Mailing Address - Fax:208-327-0594
Practice Address - Street 1:8050 NORTHVIEW ST
Practice Address - Street 2:
Practice Address - City:BOISE
Practice Address - State:ID
Practice Address - Zip Code:83704-7126
Practice Address - Country:US
Practice Address - Phone:208-327-0504
Practice Address - Fax:208-327-0594
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-18
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDLCSW283Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes283Q00000XHospitalsPsychiatric Hospital
Provider Identifiers
StateIdentifier IDID TypeIssuer
IDOTH000Medicare UPIN
ID134009Medicare ID - Type Unspecified