Provider Demographics
NPI:1669775060
Name:ABUNDANCE BEHAVIORAL HEALTH SERVICES INC.
Entity type:Organization
Organization Name:ABUNDANCE BEHAVIORAL HEALTH SERVICES INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:MOLLY
Authorized Official - Middle Name:VIRGINIA
Authorized Official - Last Name:LEGGE
Authorized Official - Suffix:
Authorized Official - Credentials:CCRC
Authorized Official - Phone:208-455-1222
Mailing Address - Street 1:201 N 21ST AVE
Mailing Address - Street 2:
Mailing Address - City:CALDWELL
Mailing Address - State:ID
Mailing Address - Zip Code:83605-4371
Mailing Address - Country:US
Mailing Address - Phone:208-455-1222
Mailing Address - Fax:208-455-2559
Practice Address - Street 1:201 N 21ST AVE
Practice Address - Street 2:
Practice Address - City:CALDWELL
Practice Address - State:ID
Practice Address - Zip Code:83605-4371
Practice Address - Country:US
Practice Address - Phone:208-455-1222
Practice Address - Fax:208-455-2559
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-12-08
Last Update Date:2010-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251C00000XAgenciesDay Training, Developmentally Disabled Services
Provider Identifiers
StateIdentifier IDID TypeIssuer
ID1669795308Medicaid
ID1891913125Medicaid
ID1659590727Medicaid