Provider Demographics
NPI:1336901560
Name:SUPPORTIVE HOUSING AND INNOVATIVE PARTNERSHIPS
Entity Type:Organization
Organization Name:SUPPORTIVE HOUSING AND INNOVATIVE PARTNERSHIPS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:KENNETH
Authorized Official - Middle Name:DALE
Authorized Official - Last Name:WIDICK
Authorized Official - Suffix:
Authorized Official - Credentials:LMSW
Authorized Official - Phone:208-412-8338
Mailing Address - Street 1:PO BOX 8803
Mailing Address - Street 2:
Mailing Address - City:BOISE
Mailing Address - State:ID
Mailing Address - Zip Code:83707-2803
Mailing Address - Country:US
Mailing Address - Phone:208-331-0900
Mailing Address - Fax:208-331-0904
Practice Address - Street 1:305 E 37TH ST
Practice Address - Street 2:
Practice Address - City:GARDEN CITY
Practice Address - State:ID
Practice Address - Zip Code:83714-6419
Practice Address - Country:US
Practice Address - Phone:208-331-0900
Practice Address - Fax:208-331-0904
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-01-24
Last Update Date:2024-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health