Healthcare Provider Details

I. General information

NPI: 1023945821
Provider Name (Legal Business Name): IMPILOCARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/06/2026
Last Update Date: 05/06/2026
Certification Date: 05/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6613 W USTICK RD
BOISE ID
83704-6161
US

IV. Provider business mailing address

6613 W USTICK RD
BOISE ID
83704-6161
US

V. Phone/Fax

Practice location:
  • Phone: 208-671-8181
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name: ERIC GATURUTURU
Title or Position: OWNER
Credential:
Phone: 208-671-8181