Healthcare Provider Details

I. General information

NPI: 1740170323
Provider Name (Legal Business Name): ANM IDAHO LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/07/2025
Last Update Date: 07/28/2026
Certification Date: 07/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10670 W OVERLAND RD
BOISE ID
83709-1327
US

IV. Provider business mailing address

11313 76TH RD
FOREST HILLS NY
11375-6672
US

V. Phone/Fax

Practice location:
  • Phone: 845-548-7800
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MORDECHAI SCHWAB
Title or Position: MEMBER
Credential:
Phone: 845-548-7800