Provider Demographics
NPI:1770646820
Name:IDEAL MENTAL HEALTH, LLC
Entity Type:Organization
Organization Name:IDEAL MENTAL HEALTH, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:IRMA
Authorized Official - Middle Name:MOLINA
Authorized Official - Last Name:RUBY
Authorized Official - Suffix:
Authorized Official - Credentials:MSW
Authorized Official - Phone:208-468-1511
Mailing Address - Street 1:16 12TH AVE S
Mailing Address - Street 2:SUITE 216
Mailing Address - City:NAMPA
Mailing Address - State:ID
Mailing Address - Zip Code:83651-3936
Mailing Address - Country:US
Mailing Address - Phone:208-468-1511
Mailing Address - Fax:208-468-1599
Practice Address - Street 1:16 12TH AVE S
Practice Address - Street 2:SUITE 216
Practice Address - City:NAMPA
Practice Address - State:ID
Practice Address - Zip Code:83651-3936
Practice Address - Country:US
Practice Address - Phone:208-468-1511
Practice Address - Fax:208-468-1599
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-19
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)