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General NPI Number Information
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NPI Number | 1114419363
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Entity Type | Organization
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Legal Business Name | NVIEW BEHAVIORAL HEALTH CLINIC OF IDAHO LLC
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Dates
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Enumeration Date | 06/04/2018
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Last Update Date | 12/17/2025
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Provider Practice Location Address
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Address Line | 533 E RIVERSIDE DR STE 120
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City | EAGLE
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State | ID
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Zip | 83616-6585
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Country | US
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Telephone | 208-906-3644
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Fax |
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Provider Business Mailing Address
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Address Line | 13213 N DECHAMBEAU WAY
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City | BOISE
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State | ID
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Zip | 83714-9429
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Country | US
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Telephone | 208-249-7014
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | MRS. KIMBERLY KAY CORDERO
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Credential | LCSW
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Telephone | 208-249-7014
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 261QM0801X
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Taxonomy Name | Mental Health Clinic/Center (Including Community Mental Health Center)
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License Number | 37650
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License Number State | ID
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