MEDICARE: NVIEW BEHAVIORAL HEALTH CLINIC OF IDAHO LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	251S00000X	Community/Behavioral Health Agency
2	261QM0801X	Mental Health Clinic/Center (Including Community Mental Health Center)	37650	ID

General Provider Information

NPI Number	:	1114419363
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NVIEW BEHAVIORAL HEALTH CLINIC OF IDAHO LLC

Provider Business Mailing Address
First Line	:	13213 N DECHAMBEAU WAY
Second Line	:
City	:	BOISE
State	:	ID
Zip	:	83714-9429
Country	:	US
Telephone Number	:	208-249-7014
Fax Number	:

Provider Business Practice Location Address
First Line	:	533 E RIVERSIDE DR STE 120
Second Line	:
City	:	EAGLE
State	:	ID
Zip	:	83616-6585
Country	:	US
Telephone Number	:	208-906-3644
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	MRS. KIMBERLY KAY CORDERO
Credential	:	LCSW
Telephone Number	:	208-249-7014

Provider Enumeration Date	:	06/04/2018
Last Update Date	:	12/17/2025

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