Provider Demographics
NPI:1497359715
Name:D, G, AND S BEHAVIORAL HEALTH LLC
Entity Type:Organization
Organization Name:D, G, AND S BEHAVIORAL HEALTH LLC
Other - Org Name:ALTITUDE MENTAL HEALTH
Other - Org Type:Doing Business As
Authorized Official - Title/Position:BUSINESS MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:ANTHONY
Authorized Official - Middle Name:
Authorized Official - Last Name:UPSHAW
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:208-696-1388
Mailing Address - Street 1:8100 W EMERALD ST STE 180
Mailing Address - Street 2:
Mailing Address - City:BOISE
Mailing Address - State:ID
Mailing Address - Zip Code:83704-9069
Mailing Address - Country:US
Mailing Address - Phone:208-342-6300
Mailing Address - Fax:208-342-6301
Practice Address - Street 1:8100 W EMERALD ST STE 180
Practice Address - Street 2:
Practice Address - City:BOISE
Practice Address - State:ID
Practice Address - Zip Code:83704-9069
Practice Address - Country:US
Practice Address - Phone:208-342-6300
Practice Address - Fax:208-342-6301
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-11-27
Last Update Date:2022-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)