Healthcare Provider Details

I. General information

NPI: 1487172003
Provider Name (Legal Business Name): COMPASSIONATE CARE FAMILY SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/04/2017
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

420 HILLCREST AVE
AMERICAN FALLS ID
83211
US

IV. Provider business mailing address

PO BOX 124
AMERICAN FALLS ID
83211-0124
US

V. Phone/Fax

Practice location:
  • Phone: 208-269-1134
  • Fax:
Mailing address:
  • Phone: 208-269-1134
  • Fax: 866-387-2237

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name: SHARON BROOKE HURT
Title or Position: MANAGING MEMBER
Credential: LPC
Phone: 208-339-8085