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General NPI Number Information
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NPI Number | 1770687857
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Entity Type | Organization
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Legal Business Name | ST. ALPHONSUS REG MED
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Dates
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Enumeration Date | 09/11/2006
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Last Update Date | 06/16/2025
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Provider Practice Location Address
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Address Line | 1055 N CURTIS RD
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City | BOISE
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State | ID
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Zip | 83706
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Country | US
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Telephone | 208-367-6230
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Fax | 208-367-3016
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Provider Business Mailing Address
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Address Line | 1055 N CURTIS RD
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City | BOISE
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State | ID
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Zip | 83706-1309
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Country | US
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Telephone | 208-367-6230
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Fax | 208-367-3016
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Authorized Official
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Title or Position | CFO
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Name | BRIAN LANNIE CHECKETTS
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Credential |
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Telephone | 208-367-7347
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 273R00000X
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Taxonomy Name | Psychiatric Hospital Unit
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License Number | 2
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License Number State | ID
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