MEDICARE: ASSURANCE BEHAVIORAL HEALTH, 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	251B00000X	Case Management Agency
2	251S00000X	Community/Behavioral Health Agency

General Provider Information

NPI Number	:	1417120304
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ASSURANCE BEHAVIORAL HEALTH, LLC.

Provider Business Mailing Address
First Line	:	12 HIGH MOUNTAIN RD
Second Line	:
City	:	BOISE
State	:	ID
Zip	:	83716-2946
Country	:	US
Telephone Number	:	208-392-4356
Fax Number	:

Provider Business Practice Location Address
First Line	:	3852 HIGHWAY 21
Second Line	:
City	:	IDAHO CITY
State	:	ID
Zip	:	83631
Country	:	US
Telephone Number	:	208-629-6523
Fax Number	:

Authorized Official
Title or Position	:	CEO/MANAGER
Name	:	JAMES L FRIES
Credential	:	BS.
Telephone Number	:	208-392-4356

Provider Enumeration Date	:	04/11/2008
Last Update Date	:	04/11/2008

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