Healthcare Provider Details

I. General information

NPI: 1003955535
Provider Name (Legal Business Name): BOISE GROUP HOMES, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/05/2007
Last Update Date: 04/29/2026
Certification Date: 04/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8310 USTICK RD
BOISE ID
83704-5757
US

IV. Provider business mailing address

PO BOX 4243
BOISE ID
83711-4243
US

V. Phone/Fax

Practice location:
  • Phone: 208-376-1861
  • Fax: 208-376-1869
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code315P00000X
TaxonomyIntellectual Disabilities Intermediate Care Facility
License Number17
License Number StateID

VIII. Authorized Official

Name: RICHARD DAVIS
Title or Position: ADMINISTRATOR
Credential:
Phone: 208-376-1861