| Hisway, Llc | |
|
8590 W Fairview Ave Boise ID 83704-8320 | |
| (208) 860-7124 | |
| (208) 672-0238 |
| Full Name | Hisway, Llc |
|---|---|
| Speciality | Day Training, Developmentally Disabled Services |
| Location | 8590 W Fairview Ave, Boise, Idaho |
| Authorized Official Name and Position | Ellen Marie Hampton (ADMINISTRATOR/OWNER) |
| Authorized Official Contact | 2088607124 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Hisway, Llc 8590 W Fairview Ave Boise ID 83704-8320 Ph: (208) 860-7124 | Hisway, Llc 8590 W Fairview Ave Boise ID 83704-8320 Ph: (208) 860-7124 |
| NPI Number | 1770917866 |
|---|---|
| Provider Enumeration Date | 08/26/2013 |
| Last Update Date | 07/14/2022 |
| Certification Date | 07/14/2022 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1770917866 | NPI | - | NPPES |
| 1770917866 | Medicaid | ID |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 251S00000X | Community/behavioral Health | LCSW820 (Idaho) | Secondary |
| 251C00000X | Day Training, Developmentally Disabled Services | (* (Not Available)) | Primary |
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