Provider Demographics
NPI:1598145252
Name:HUMAN SUPPORTS OF IDAHO, INC
Entity Type:Organization
Organization Name:HUMAN SUPPORTS OF IDAHO, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMIN
Authorized Official - Prefix:
Authorized Official - First Name:ALTIA
Authorized Official - Middle Name:
Authorized Official - Last Name:RUBY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:208-454-8389
Mailing Address - Street 1:PO BOX 820
Mailing Address - Street 2:
Mailing Address - City:CALDWELL
Mailing Address - State:ID
Mailing Address - Zip Code:83606-0820
Mailing Address - Country:US
Mailing Address - Phone:208-454-8389
Mailing Address - Fax:
Practice Address - Street 1:314 BADIOLA ST
Practice Address - Street 2:
Practice Address - City:CALDWELL
Practice Address - State:ID
Practice Address - Zip Code:83605-4389
Practice Address - Country:US
Practice Address - Phone:208-454-8389
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-06-08
Last Update Date:2015-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health