Healthcare Provider Details

I. General information

NPI: 1417507377
Provider Name (Legal Business Name): UNBRIDLED HOPE INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/12/2019
Last Update Date: 07/23/2024
Certification Date: 07/23/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4120 E 200 N
RIGBY ID
83442-5975
US

IV. Provider business mailing address

PO BOX 372
RIGBY ID
83442-0372
US

V. Phone/Fax

Practice location:
  • Phone: 208-538-3450
  • Fax:
Mailing address:
  • Phone: 208-201-7617
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name: JOANNA TRUSSEL BERG
Title or Position: EXECUTIVE DIRECTOR
Credential: LCSW
Phone: 208-201-7617