Healthcare Provider Details

I. General information

NPI: 1114419363
Provider Name (Legal Business Name): NVIEW BEHAVIORAL HEALTH CLINIC OF IDAHO LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/04/2018
Last Update Date: 06/04/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3709 N LOCUST GROVE RD STE 100
MERIDIAN ID
83646-6450
US

IV. Provider business mailing address

13213 N DECHAMBEAU WAY
BOISE ID
83714-9429
US

V. Phone/Fax

Practice location:
  • Phone: 208-957-5360
  • Fax:
Mailing address:
  • Phone: 208-249-7014
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number37650
License Number StateID

VIII. Authorized Official

Name: MRS. KIMBERLY KAY CORDERO
Title or Position: OWNER
Credential: LCSW
Phone: 208-249-7014