Provider Demographics
NPI:1669739272
Name:NETWORK HOMES MENTAL HEALTH FOUNDATION CORP
Entity type:Organization
Organization Name:NETWORK HOMES MENTAL HEALTH FOUNDATION CORP
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:FOUNDER
Authorized Official - Prefix:MR
Authorized Official - First Name:TODD
Authorized Official - Middle Name:
Authorized Official - Last Name:OLSHEFSKI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:208-344-2197
Mailing Address - Street 1:5460 W FRANKLIN RD
Mailing Address - Street 2:SUITE B
Mailing Address - City:BOISE
Mailing Address - State:ID
Mailing Address - Zip Code:83705-1080
Mailing Address - Country:US
Mailing Address - Phone:208-344-2197
Mailing Address - Fax:208-342-3094
Practice Address - Street 1:5460 W FRANKLIN RD
Practice Address - Street 2:SUITE B
Practice Address - City:BOISE
Practice Address - State:ID
Practice Address - Zip Code:83705-1080
Practice Address - Country:US
Practice Address - Phone:208-344-2197
Practice Address - Fax:208-342-3094
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:NETWORK HOMES MENTAL HEALTH CORP
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2012-04-19
Last Update Date:2012-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
251B00000X, 261QM0850X
ID251S00000X, 261QM0801X, 302R00000X, 310500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health
No251B00000XAgenciesCase Management
No251S00000XAgenciesCommunity/Behavioral Health
No261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
No302R00000XManaged Care OrganizationsHealth Maintenance Organization
No310500000XNursing & Custodial Care FacilitiesIntermediate Care Facility, Mental Illness
Provider Identifiers
StateIdentifier IDID TypeIssuer
IDA0001198Medicaid