Provider Demographics
NPI:1881707552
Name:BHC INTERMOUNTAIN HOSPITAL, INC.
Entity type:Organization
Organization Name:BHC INTERMOUNTAIN HOSPITAL, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SR VP CFO
Authorized Official - Prefix:
Authorized Official - First Name:STEVE
Authorized Official - Middle Name:
Authorized Official - Last Name:FILTON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:610-768-3300
Mailing Address - Street 1:303 ALLUMBAUGH ST
Mailing Address - Street 2:
Mailing Address - City:BOISE
Mailing Address - State:ID
Mailing Address - Zip Code:83704-9208
Mailing Address - Country:US
Mailing Address - Phone:208-377-8400
Mailing Address - Fax:208-377-4749
Practice Address - Street 1:303 ALLUMBAUGH ST
Practice Address - Street 2:
Practice Address - City:BOISE
Practice Address - State:ID
Practice Address - Zip Code:83704-9208
Practice Address - Country:US
Practice Address - Phone:208-377-8400
Practice Address - Fax:208-377-4749
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-16
Last Update Date:2011-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ID20296320800000X
ID46283Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes283Q00000XHospitalsPsychiatric Hospital
No320800000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Mental Illness
Provider Identifiers
StateIdentifier IDID TypeIssuer
AKHS493PIOtherRESIDENTAIL AND INPATIENT
ID00711OtherINPATIENT HOSPITAL
MT4100349OtherRESIDENTAIL TREATMENT FAC
ID805048800Medicaid
ID000010012598OtherINPATIENT
ID134002Medicare Oscar/Certification