Provider Demographics
NPI:1477016947
Name:INTRINSIC HOLDINGS CORP
Entity Type:Organization
Organization Name:INTRINSIC HOLDINGS CORP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:SHAWN
Authorized Official - Middle Name:
Authorized Official - Last Name:JOHANSSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:208-716-3259
Mailing Address - Street 1:PO BOX 1672
Mailing Address - Street 2:
Mailing Address - City:IDAHO FALLS
Mailing Address - State:ID
Mailing Address - Zip Code:83403-1672
Mailing Address - Country:US
Mailing Address - Phone:208-716-3259
Mailing Address - Fax:
Practice Address - Street 1:9006 E CEDAR POINT LN
Practice Address - Street 2:
Practice Address - City:IDAHO FALLS
Practice Address - State:ID
Practice Address - Zip Code:83401-4834
Practice Address - Country:US
Practice Address - Phone:208-716-3259
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-04-10
Last Update Date:2019-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320900000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities