| Human Supports Of Idaho, Inc. | |
|
4477 W Emerald St Ste C-100 Boise ID 83706-2000 | |
| (208) 321-0160 | |
| (208) 321-0221 |
| Full Name | Human Supports Of Idaho, Inc. |
|---|---|
| Speciality | Community/behavioral Health |
| Location | 4477 W Emerald St, Boise, Idaho |
| Authorized Official Name and Position | Gregory L Dickerson (ADMINISTRATOR) |
| Authorized Official Contact | 2083210160 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Human Supports Of Idaho, Inc. Po Box 820 Caldwell ID 83606-0820 Ph: (208) 454-8389 | Human Supports Of Idaho, Inc. 4477 W Emerald St Ste C-100 Boise ID 83706-2000 Ph: (208) 321-0160 |
| NPI Number | 1558404129 |
|---|---|
| Provider Enumeration Date | 02/14/2007 |
| Last Update Date | 12/18/2012 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1558404129 | NPI | - | NPPES |
| 002800000 | Medicaid | ID |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 251S00000X | Community/behavioral Health | (* (Not Available)) | Primary |
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