Healthcare Provider Details

I. General information

NPI: 1174488746
Provider Name (Legal Business Name): BH-ID OPCO IF, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/17/2025
Last Update Date: 12/17/2025
Certification Date: 12/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

383 ENERGY DR
IDAHO FALLS ID
83401-4880
US

IV. Provider business mailing address

PO BOX 12125
PORTLAND OR
97212-0125
US

V. Phone/Fax

Practice location:
  • Phone: 986-202-8190
  • Fax:
Mailing address:
  • Phone: 619-889-3399
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code323P00000X
TaxonomyPsychiatric Residential Treatment Facility
License Number
License Number State

VIII. Authorized Official

Name: CHAD ENGBRECHT
Title or Position: GENERAL COUNSEL
Credential:
Phone: 858-254-2510