Provider Demographics
NPI:1437208899
Name:AUTOBUS VENTURES, LLC
Entity Type:Organization
Organization Name:AUTOBUS VENTURES, LLC
Other - Org Name:ALPINE BEHAVIORAL HEALTH
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:BRADLEY
Authorized Official - Middle Name:
Authorized Official - Last Name:MIDGETT
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:208-672-0260
Mailing Address - Street 1:8590 W FAIRVIEW AVE STE A
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:208-672-0260
Mailing Address - Fax:208-321-7750
Practice Address - Street 1:8590 W FAIRVIEW AVE STE A
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:208-672-0260
Practice Address - Fax:208-321-7750
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-08
Last Update Date:2022-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
261QM0801X
IDLCSW-24969305S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
No305S00000XManaged Care OrganizationsPoint of Service
Provider Identifiers
StateIdentifier IDID TypeIssuer
ID807585600Medicaid