MEDICARE: JUST 4 KIDS HEALTH LLC

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy
1	101Y00000X	Counselor
2	103T00000X	Psychologist
3	363LP0808X	Psychiatric/Mental Health Nurse Practitioner
4	1041C0700X	Clinical Social Worker
5	101YM0800X	Mental Health Counselor

General Provider Information

NPI Number	:	1700651221
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	JUST 4 KIDS HEALTH LLC

Provider Business Mailing Address
First Line	:	PO BOX 1407
Second Line	:
City	:	IDAHO FALLS
State	:	ID
Zip	:	83403-1407
Country	:	US
Telephone Number	:	208-534-7881
Fax Number	:	208-203-7067

Provider Business Practice Location Address
First Line	:	2105 CORONADO STREET
Second Line	:
City	:	IDAHO FALLS
State	:	ID
Zip	:	83404
Country	:	US
Telephone Number	:	208-534-7881
Fax Number	:	208-242-4464

Authorized Official
Title or Position	:	OWNER
Name	:	AARON HOWARD GARDNER
Credential	:	MD
Telephone Number	:	208-534-7881

Provider Enumeration Date	:	11/15/2023
Last Update Date	:	02/16/2026

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Directions to “JUST 4 KIDS HEALTH LLC ” Practice Location

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