NPI Code Detail JSON Logo

1306543228 NPI number — EAST IDAHO YOUTH HOMES LLC

NPI Number: 1306543228
Health Care Provider/Practitioner: EAST IDAHO YOUTH HOMES LLC

Information about “1306543228” NPI (EAST IDAHO YOUTH HOMES LLC) exists in 1306543228 in HTML format HTML  |  1306543228 in plain Text format TXT  |  1306543228 in PDF (Portable Document Format) PDF  |  1306543228 in an XML format XML  formats.

NPI Number : 1306543228 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1306543228",
    "EntityType": "Organization",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": null,
    "IsOrgSubpart": "N",
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": "EAST IDAHO YOUTH HOMES LLC",
    "LastName": null,
    "FirstName": null,
    "MiddleName": null,
    "NamePrefix": null,
    "NameSuffix": null,
    "Credential": null,
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": null,
    "OtherFirstName": null,
    "OtherMiddleName": null,
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": null,
    "OtherLastNameTypeCode": null,
    "FirstLineMailingAddress": "550 LINDEN DR",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "IDAHO FALLS",
    "MailingAddressStateName": "ID",
    "MailingAddressPostalCode": "83401-4149",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "208-360-8102",
    "MailingAddressFaxNumber": null,
    "FirstLinePracticeLocationAddress": "550 LINDEN DR",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "IDAHO FALLS",
    "PracticeLocationAddressStateName": "ID",
    "PracticeLocationAddressPostalCode": "83401-4149",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "208-360-8102",
    "PracticeLocationAddressFaxNumber": null,
    "EnumerationDate": "02/10/2023",
    "LastUpdateDate": "02/10/2023",
    "NPIDeactivationReasonCode": null,
    "NPIDeactivationReason": null,
    "NPIDeactivationDate": null,
    "NPIReactivationDate": null,
    "GenderCode": null,
    "Gender": null,
    "AuthorizedOfficialLastName": "TORNKVIST",
    "AuthorizedOfficialFirstName": "KAREN",
    "AuthorizedOfficialMiddleName": "FAYE",
    "AuthorizedOfficialTitle": "CHIEF ADMINISTRATOR",
    "AuthorizedOfficialNamePrefix": null,
    "AuthorizedOfficialNameSuffix": null,
    "AuthorizedOfficialCredential": null,
    "AuthorizedOfficialTelephoneNumber": "208-360-8102",
    "Taxonomies": {
      "Taxonomy": [
        {
          "TaxonomyCode": "251B00000X",
          "TaxonomyName": "Case Management Agency",
          "LicenseNumber": null,
          "LicenseNumberStateCode": null,
          "PrimaryTaxonomySwitch": "N"
        },
        {
          "TaxonomyCode": "320800000X",
          "TaxonomyName": "Mental Illness Community Based Residential Treatment Facility",
          "LicenseNumber": null,
          "LicenseNumberStateCode": null,
          "PrimaryTaxonomySwitch": "N"
        },
        {
          "TaxonomyCode": "320900000X",
          "TaxonomyName": "Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility",
          "LicenseNumber": null,
          "LicenseNumberStateCode": null,
          "PrimaryTaxonomySwitch": "N"
        },
        {
          "TaxonomyCode": "101YM0800X",
          "TaxonomyName": "Mental Health Counselor",
          "LicenseNumber": null,
          "LicenseNumberStateCode": null,
          "PrimaryTaxonomySwitch": "Y"
        }
      ]
    },
    "HealthcareProviderTaxonomyGroups": {
      "HealthcareProviderTaxonomyGroup": {
        "HealthcareProviderTaxonomyGroupName": "193200000X MULTI-SPECIALTY GROUP",
        "HealthcareProviderTaxonomyGroupDescription": "Multi-Specialty Group - A business group of one or more individual practitioners, who practice with different areas of specialization."
      }
    }
  }
}
                
            

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