Healthcare Provider Details

I. General information

NPI: 1770917866
Provider Name (Legal Business Name): HISWAY, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/26/2013
Last Update Date: 07/14/2022
Certification Date: 07/14/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8590 W FAIRVIEW AVE
BOISE ID
83704-8320
US

IV. Provider business mailing address

8590 W FAIRVIEW AVE
BOISE ID
83704-8320
US

V. Phone/Fax

Practice location:
  • Phone: 208-860-7124
  • Fax: 208-672-0238
Mailing address:
  • Phone: 208-860-7124
  • Fax: 208-672-0238

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251C00000X
TaxonomyDevelopmentally Disabled Services Day Training Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License NumberLCSW820
License Number StateID

VIII. Authorized Official

Name: MS. ELLEN MARIE HAMPTON
Title or Position: ADMINISTRATOR/OWNER
Credential:
Phone: 208-860-7124