Healthcare Provider Details

I. General information

NPI: 1205763406
Provider Name (Legal Business Name): GUIDING STAR RESIDENCE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/04/2026
Last Update Date: 05/08/2026
Certification Date: 05/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6751 S SOLAR AVE
BOISE ID
83709-6383
US

IV. Provider business mailing address

6751 S SOLAR AVE
BOISE ID
83709-6383
US

V. Phone/Fax

Practice location:
  • Phone: 208-995-5594
  • Fax:
Mailing address:
  • Phone: 208-995-5594
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code320600000X
TaxonomyIntellectual and/or Developmental Disabilities Residential Treatment Facility
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code322D00000X
TaxonomyEmotionally Disturbed Childrens' Residential Treatment Facility
License Number
License Number State

VIII. Authorized Official

Name: SALMA KASSIM
Title or Position: OWNER
Credential:
Phone: 208-995-5594