Organization · NPI-2

Idaho Youth Ranch

Clinic/Center, Adolescent and Children Mental Health · Boise, ID

NPI number1952738262
StatusActive
Last updated in NPPESApr 6, 2023

Details

NPI
1952738262
Entity type
Organization (NPI-2)
Legal business name
Idaho Youth Ranch
Organization subpart
No
Enumeration date
Oct 1, 2013
Certification date
Apr 6, 2023
Last updated
Apr 6, 2023

Taxonomy and licenses

Taxonomy codeDescriptionLicenseStatePrimary
261QM0855X Clinic/Center, Adolescent and Children Mental Health––Yes
322D00000X Residential Treatment Facility, Emotionally Disturbed Children––
323P00000X Psychiatric Residential Treatment Facility––
324500000X Substance Abuse Rehabilitation Facility–ID
385HR2055X Respite Care, Respite Care, Mental Illness, Child––

Practice location

5465 W Irving St
Boise, ID 83706-1213

Phone 208-377-2613

Mailing address

5465 W Irving St
Boise, ID 83706-1213

Authorized official

Kimberly Thomas
Cfo
2083772613

Is something wrong?

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