Healthcare Provider Details

I. General information

NPI: 1104048503
Provider Name (Legal Business Name): COMMUNITY PARTNERSHIPS OF IDAHO, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/03/2007
Last Update Date: 09/09/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3214 N ACRE LN
BOISE ID
83704-4501
US

IV. Provider business mailing address

3098 N FIVE MILE RD
BOISE ID
83713-5215
US

V. Phone/Fax

Practice location:
  • Phone: 208-376-7846
  • Fax: 208-549-7294
Mailing address:
  • Phone: 208-376-4999
  • Fax: 208-376-4988

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QD1600X
TaxonomyDevelopmental Disabilities Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM0855X
TaxonomyAdolescent and Children Mental Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: VICTORIA BRIGHT
Title or Position: MANAGER
Credential:
Phone: 208-405-0587