Healthcare Provider Details

I. General information

NPI: 1235033663
Provider Name (Legal Business Name): GEMBA BOISE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/07/2026
Last Update Date: 10/07/2026
Certification Date: 10/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1491 E TYRELL LN SUITE 100
BOISE ID
83706
US

IV. Provider business mailing address

PO BOX 112
EMMETT ID
83617-0112
US

V. Phone/Fax

Practice location:
  • Phone: 208-254-1433
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number StateNULL

VIII. Authorized Official

Name: AMEE HARDY
Title or Position: EXECUTIVE DIRECTOR/CO-OWNER
Credential: LCPC
Phone: 208-254-1433