Healthcare Provider Details

I. General information

NPI: 1417894296
Provider Name (Legal Business Name): AXIOM COMMUNITY SERVICES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/30/2026
Last Update Date: 04/30/2026
Certification Date: 04/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10552 W GARVERDALE CT STE 904B
BOISE ID
83704-5478
US

IV. Provider business mailing address

10552 W GARVERDALE CT STE 904B
BOISE ID
83704-5478
US

V. Phone/Fax

Practice location:
  • Phone: 208-891-3456
  • Fax: 208-616-1533
Mailing address:
  • Phone: 208-891-3456
  • Fax: 208-616-1533

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name: MOHSEN AMIRMOJAHEDI
Title or Position: MANAGER
Credential:
Phone: 208-701-4498