Healthcare Provider Details

I. General information

NPI: 1881707552
Provider Name (Legal Business Name): BHC INTERMOUNTAIN HOSPITAL, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/16/2006
Last Update Date: 03/07/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

303 ALLUMBAUGH ST
BOISE ID
83704-9208
US

IV. Provider business mailing address

303 ALLUMBAUGH ST
BOISE ID
83704-9208
US

V. Phone/Fax

Practice location:
  • Phone: 208-377-8400
  • Fax: 208-377-4749
Mailing address:
  • Phone: 208-377-8400
  • Fax: 208-377-4749

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code283Q00000X
TaxonomyPsychiatric Hospital
License Number46
License Number StateID
# 2
Primary TaxonomyN
Taxonomy Code320800000X
TaxonomyMental Illness Community Based Residential Treatment Facility
License Number20296
License Number StateID

VIII. Authorized Official

Name: STEVE FILTON
Title or Position: SR VP CFO
Credential:
Phone: 610-768-3300