Healthcare Provider Details

I. General information

NPI: 1154034189
Provider Name (Legal Business Name): AFFIRM HUMAN SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/04/2023
Last Update Date: 01/19/2023
Certification Date: 01/19/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2743 E IONA RD
IDAHO FALLS ID
83401-1343
US

IV. Provider business mailing address

2743 E IONA RD
IDAHO FALLS ID
83401-1343
US

V. Phone/Fax

Practice location:
  • Phone: 208-520-2929
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code320600000X
TaxonomyIntellectual and/or Developmental Disabilities Residential Treatment Facility
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number StateNULL

VIII. Authorized Official

Name: ANGEL L JOHNSON
Title or Position: CHIEF ADMIN OFFICER
Credential:
Phone: 208-520-2929