Healthcare Provider Details

I. General information

NPI: 1649125915
Provider Name (Legal Business Name): CODY HAFER
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/03/2026
Last Update Date: 03/03/2026
Certification Date: 03/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

160 9TH AVE E
TWIN FALLS ID
83301-6327
US

IV. Provider business mailing address

963 S ORCHARD ST STE 101
BOISE ID
83705-1917
US

V. Phone/Fax

Practice location:
  • Phone: 208-605-9860
  • Fax:
Mailing address:
  • Phone: 208-605-9860
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: